Medical Woman 1013 by The Magazine Production Company

MEDICAL WOMAN volume 32: issue 2

autumn/winter 2013

inside: Pension Tension how do the changes affect you? Women At The Top Professor Jenny Higham Twitterview Dr Helena McKeown The Forgotten Women Dr Jodie Smythe

www.medicalwomensfederation.org.uk

Editor’s Letter

n this issue we hear from the MWF Officers on page 3 including our two new additions – Dr Charlotte Gath and Professor Parveen Kumar (“How I got here” page 18); as well as news of members and local groups from around the UK (p4) and abroad (p5). The MWF Spring Conference in Oxford in May was a huge success (p6), and you can read the oral presentation winner’s report on page 27.

Image thanks to lolography.com

Recent changes to the NHS pension have bewildered me, and I’m sure you will find Dr Mark Porter BMA Council Chair’s articles on page 12 a useful read. We feature two inspiring women in this issue; “Twitterview” is with Dr Helena McKeown, GP, BMA GPC member and a Councillor in Wiltshire; and “Women at the Top” is with Professor Jenny Higham, Consultant Gynaecologist and Vice Dean & Director of Education in the Faculty of Medicine at Imperial College. As an Imperial College alumnus I have always been in awe of how much Professor Higham has achieved, whilst still being very approachable to medical students. The support of these two prominent medical women is very much appreciated by the MWF, and Medical Woman magazine. Thank you for your comments on our last issue. We aim to continue to develop this magazine, and have had some changes to the team as a result. Dr Yasmin Drabu has taken on the Officer aspect of the Editor’s role, and will deputise for me as I’m currently 34 weeks pregnant so will have some time off whilst getting used to becoming a new mother! We have three new additions to the team, and are pleased to welcome Dr Beccy Say as the new Junior Editor. Beccy is an Academic O&G Trainee in Newcastle. We also have 2 new Student Editors – Brooke Calvert, a UCL Final Year student, and Amy a 3rd year Medical Student at St Georges Medical School. I hope our new team flourish and take forward Medical Woman, the only magazine in the UK for female doctors.

“Far away there in the sunshine are my highest aspirations. I may not reach them, but I can look up and see their beauty, believe in them, and try to follow where they lead.” Louisa May Alcott

Sara Khan, Editor of Medical Woman doctorsarahkhan@gmail.com @DrSaraK about.me/sarakhan

Contents

Contents Medical Woman, produced by the Medical Women’s Federation Editor: Dr Sara Khan doctorsarahkhan@gmail.com Deputy Editor: Yasmin Drabu ynaqushbandi@yahoo.co.uk Assistant Editors: Ms Anji Thomas and Miss Francesca Rutherford E-mail: admin.mwf@btconnect.com MEDICAL WOMEN’S FEDERATION Tavistock House North, Tavistock Square, London WC1H 9HX Tel: 020 7387 7765 Fax: 020 7388 9216

Officers Update

Grieving the Child I Long For

News / Events

Listening to the Body

HRH The Duchess of Gloucester GCVO

Autumn Meeting Write Up

Junior Doctor Prize Winner

President: Dr Fiona Cornish

Move Eat Treat

FGM

Say it, Write it, Tweet it

The Forgotten Woman

TwitterView

The Mummy Diaries

Women at the Top

Coaching for Health

Pension Tension

Essay Prize

Top Apps

Elective

Debate

Careers Clinic

Charity Focus

Tips for Students

Interpersonal Violence

Obituaries

How I got Here

Dr Iona Frock

E-mail: admin.mwf@btconnect.com www.medicalwomensfederation.org.uk Patron:

fecornish@btinternet.com President-Elect: Dr Sally Davies sallyjanedavies@gmail.com Vice President: Professor Parveen Kumar Honorary Secretary: Dr Beryl De Souza bds@dr.com Honorary Treasurer: Dr Charlotte Gath charlottegath@aol.com Design & Production: The Magazine Production Company www.magazineproduction.com

Medical Woman: © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without the prior written consent of the Publisher. A reprint service is available. Great care is taken to ensure accuracy in the preparation of this publication, but Medical Woman can not be held responsible for its content. The views expressed are those of the contributors and not necessarily those of the Publisher.

www.medicalwomensfederation.org.uk

Contributors

Contributors AUTUMN 2013

Dr ShanShan Jing Cover Image

A medical woman you admire/respect:

Dr ShanShan Jing

I don’t have a particular one. I respect all who have contributed to medicine, particularly women who faced prejudice in life: Kathryn Stephenson, Elizabeth Garrett Anderson, Florence Nightingale, Rosalind Franklin

Five favourite things in life: Things are materialistic, I have one rule in life and that is to take risks and live it to its full! :)

Cicely Saunders

Five favourite things in life: • Lying on the grass watching clouds with my husband • My puppy Albie • The sunrise on a clear day over the mountains • Making a really good diagnosis • Learning a new craft.

Mummy Diaries, pg 26

How I got Here, pg 18

The late Dr Ann McPherson. An inspiration in so many important parts of medicine – hearing and sharing the patient experience, accessible health education (I read the Diary of a Teenage Health Freak when I was a teenager!) and a strong stand on important ethical issues.

• My girls (young and old) • Chilled white wine in a beautiful place • Exploring overseas • Modern architecture & design • Working on something I am passionate about

Dr Helen MacMullen Aspects of Pain, Spring Conference Review, pg 6

A medical woman you admire/respect: Every medical woman I meet is an inspiration in their own way. We have a lot to learn from each and every person we meet.

Five favourite things in life: • Creative cooking and enjoying the results with family and friends • Spending time with my daughters, Lydia 6 and Anna 4, and my incredible husband :) • My bike! I would be lost without it • A&E night shifts (weirdly) • Dancing and yoga :) (ok, that’s 6!)

A medical woman you admire/respect:

Professor Parveen Kumar

Five favourite things in life:

Dr Helen MacMullen

Grieving the Child I long for, pg 20

Dr Ilana Levene A medical woman you admire/respect:

Dr Ilana Levene

Angela Nelmes

A medical woman you admire/respect: Marie Currie and Florence Nightingale for their tenacity.

Five favourite things in life: • Family •M edicine – particularly teaching medicine • S kiing and walking in the mountains • Opera • Travel and wine

Professor Parveen Ku mar

Dr Lazara Dominguez Garcia Female Genital Mutilation, designing and delivering a dedicated multidisciplinary service for affected women, pg 22

A medical woman you admire/respect: Elizabeth Garrett Anderson for playing an instrumental role in encouraging the acceptance of female professionals in the world of medicine.

Dr Lazara Dominguez Garcia

Five favourite things in life: • The love and support of my son and my family • Being a doctor • The diversity that everyone brings to the table • Freedom of choice • Second chances

Medical Woman | Autumn 2013

Officers’ Update

MWF Officers’ Report Read about what the elected MWF Officers have been up to: Dr Fiona Cornish, President

The highlight of May was the very successful Spring Meeting in Oxford, Aspects of Pain, attended by over 100 delegates. Please read the meeting report in this edition. We were delighted to welcome Prof Parveen Kumar (who is featured in this edition) and Dr Charlotte Gath as new officers immediately after the Council Meeting. The furore over part time women GPs being a burden to the NHS sparked a flurry of discussion and I found myself on Woman’s Hour talking to Jenni Murray with the Health Minister, Anna Soubry MP. Naturally, there had been some journalistic misrepresentation and Anna Soubry corrected those on the show. I stressed that men and women both wish to work less than full time; that women are good value to the health service if they can work part time at critical stages, and then return to work full time and stay until retirement; workforce planning needs to adapt to reflect the changing work patterns in society, allowing young men and women to participate in bringing up their families. If you would like to listen, the link is www.bbc.co.uk/programmes/b02qncqz Other news includes MWF giving evidence to the Shape of Training Review. Prof Jean McEwan (Immediate Past MWF Vice-President) and I met Prof David Greenaway for an hour and emphasised the benefits of keeping women in the workforce through the critical years of training, and the idea that less than full time training should be mainstream rather than a special case. Dr Sue Overal comes to the end of her tenure as the BMA GPC (General Practitioner Committee) Rep for MWF in July, and I am grateful for the votes that elected me to take her place. It is so important that we make the most of the opportunities to contribute to influential bodies like the GPC, and make our voice heard. Dr Sally Davies, President-Elect

Sally is currently on sabbatical in New Zealand, but is keeping in touch via her blog; http://bit.ly/18zo5Rf Dr Beryl De Souza, Honorary Secretary

We have been approached by Sky News on a number of occasions to provide women experts for News stories and we are delighted to have our members involved. We have had excellent feedback from our Sky News Producer colleagues and would encourage you to let us know if you’re interested in being involved with the media. Following our May council meeting we have approached all the Royal Colleges to find out what they are doing for women doctor members. We are looking at possible collaborative opportunities with the Royal Colleges to ensure that there is enough support and to provide an MWF presence. We are in the process of changeover with our MWF medical school representatives as some graduate to junior doctors; congratulations and we look forward to continued work with www.medicalwomensfederation.org.uk

them, perhaps as MWF Junior Doctor representatives. Get in touch if you are interested in taking on a new role within MWF. Finally, the MWF recruitment drive pledge – what are you doing about it? We have an exciting Autumn Conference “Patient and Doctors Safety; Can women change the culture of the NHS?” coming up on Friday 8th November 2013 which presents an ideal opportunity to invite a friend or colleague. Please visit medicalwomensfederation.org.uk to register and pay online! Dr Charlotte Gath, Honorary Treasurer

I have just stepped into the role of Honorary Treasurer of MWF, and am taking over from Yasmin Drabu, who has done an excellent job, and I am very grateful for her continuing support as she remains in post as an MWF Officer. At the Council meeting in Oxford on 10th May, Yasmin presented her Annual Report for 2012. So the immediate priorities in my role for the coming year are to continue to raise the profile of MWF, improve efficiency and reduce costs, whilst working to our core aims. Within that, the implementation of the Recruitment and Retention Strategy (also discussed at the May Council meeting) is a key priority. We have had membership drives at regular intervals in recent years but continuing to focus on attracting – and retaining – new members remains a top concern. Despite this, MWF’s awarding of grants and prizes continues to attract new members and it has been agreed that from 2013 the awarding of grants and prizes from the grants’ fund will (in all but the Junior Doctor Prize) be to members only. One of my first jobs on coming into post has been to assess the Mature Student Grant applications choosing those to whom awards will be made. It has made fascinating reading and inspires real admiration for the determination and commitment of some of our mature medical student members in tackling financial hardship and difficult circumstances in undertaking their medical student training. On a personal note to introduce myself, I have been a member of MWF for around 15 years. My background is in general practice and public health. I currently work half-time as a Consultant in Public Health in Warwickshire, and part-time as a GP tutor at Warwick Medical School (with a bit of general practice thrown in!) and have responsibility for designing a new primary and community care course for undergraduate medical students, in the context of the recent Health Education England mandate that medical schools should aim to produce 50% of graduates aiming to work in general practice. Exciting times! Dr Yasmin Drabu, Deputy Editor of Medical Woman

We have appointed two new Student Editors, and one Junior Editor who is an Academic O&G Trainee in Newcastle. We have offered other ways to become involved with the MWF to those who weren’t successful in the appointment process; and we continue to look at ways we can encourage, support and retain our members. 3

News/Events

Events & Members News MWF Student Representatives Want to put something amazing on your CV?! We’re looking for MWF student representatives at UCL, Bristol, Cardiff, Southampton and Durham Universities! If you’re interested get in touch!

MWF Members News: • Congratulations to MWF members Jane Dacre, Suzy Lishman, Kim Holt and Fiona Cornish for being included on the inaugural HSJ Inspirational Women in Healthcare List. • Congratulations to all new graduates! Don’t forget to update your contact email and address with MWF. • Congratulations to our members who recently won ACCEA awardsAmanda Howe and Rachael Liebmann. • Congratulations to Su-Anna Boddy who was elected onto RCS England Council. • Our MWIA contingent represented MWF at the 29th International Congress of MWIA, Seoul, Korea, 31st July – 3rd August 2013 – read the review below.

MWF in the Media • Dr Beryl De Souza was invited onto Sky News to discuss Plastic Surgery regulations, highlighted in the Keogh report. • BBC Radio 4 Women’s Hour: ‘Part-Time GP’s’ As more women than men train as GPs what affect will that have on patients and the NHS? Dr Fiona Cornish and Anna Soubry MP discussed this issue on Radio 4 Women’s Hour:www.bbc.co.uk/programmes/p01bc95k. • Dr Scarlett McNally was on Sky News discussing why Surgery mortality rates are higher at the weekends. • Why are there so few female specialists in the media, and how can this be changed?” Dr Beryl De Souza (MWF Hon Sec) & Tami Hoffman on the BMJ Careers Site. • There are plenty of chances to get into the media with MWF – let us know if you would like to be contacted in the future!

Dates for your Diary: October – January – MWF Elective Bursaries open 2nd October – Hobbs Shopping and Networking Event 18th-19th October – MWF Stand at BMJ Careers Fair November – March – MWF Travel Scholarship open 8th November – MWF November Meeting, London – “Patient and Doctor Safety: Can Women Change the Culture of the NHS”

Bristol, by Dr Fiona Cornish, MWF President I attended a most inspiring celebration in July; the launch of the Elizabeth Blackwell Institute for Health Research. The director, Prof Jeremy Tavare, chose to use the name of the first woman on the UK medical register, as she was born in Bristol. The name would not have been considered had it not been for the MWF requesting a blue plaque to go up on the house where she lived. Jeremy said “We cannot think of a better icon and role model for our Institute.” I joined a trio of MWF professors, Selena Gray, Debbie Sharp and Bhu Sandhu, and longstanding Bristol member, Pat Burton, as VIP guests, along with about twenty members of the Blackwell Family. Three female members of the family, completed the official unveiling of the plaque, to a delighted 700 strong audience. To complete the evening, the Bristol MWF group arranged dinner at a local restaurant and I was delighted to meet the two Bristol student reps. Many thanks to South West Local Secretary, Selena Gray, for inviting me to such a memorable occasion.

Nottingham Local Group, by Dr Yin Ng, MWF Nottingham Local Secretary We have had two meetings recently to meet and hear from the students to whom we gave small elective bursary awards. A small group of us met at my house and we heard from, amongst others, Eshaa Sharma (Nottingham) who went to Cusco in Peru and from Sabina HanomanSingh (Leicester) who told us about the time she spent in Kuala Lumpur, Malaysia. It was interesting to hear about their experiences and also how they had set about choosing where to go. Over dinner, we were able to talk informally and share career experiences and other stories. The following week we had a Saturday day time meeting in Leicester at the Royal Infirmary Maternity Hospital seminar room. Jenny Hong, Leicester MWF student rep, and her friends had publicized the event, and also made delicious snacks and cakes. We heard from Tamsin Lane who went to Peru, and from Wanding Yang and Rebecca Partridge who went to St. Vincent and the Grenadines in the Caribbean. They all were struck by the lack of healthcare resources in these countries and differences in the doctor-patient relationship. Tamsin had tried to find out about women in medicine in Peru but found very little information. Ding told us that diabetes was very common and that amputations for diabetic foot were frequently done. Over refreshments, we were all able to network and ask questions of each other.

Scottish Eastern Local Group, Dr Catherine Harkin, MWF Scottish Eastern Local Secretary

February – June 2014 – MWF Mature Student Grants open

A small but perfectly formed Garden Party was held by the Scottish Eastern group on Saturday 22nd June at my home. Co-operation from the weather was limited, but tea, scones, cream strawberries were consumed in quantity; old friendships renewed and new connections made. A variety of creative headgear was worn and we have saved a seat for next year for you…!

8th March 2014 – International Women’s Day – MWF event to be announced

Oxford Local Group, Dr Helen MacMullen,

December – March – MWF Student Essay Prize open January 2014 – New MWF Subscription fees

9th May 2014 – MWF May Meeting, Birmingham – “Diversity and Medical Careers” 4th– 6th September 2014 – MWIA 17th Northern European Regional Conference, Copenhagen

MWF Local Groups News

MWF Oxford Local Committee member We had an intimate and interesting presentation evening in Oxford from our elective award winners: Claire Kerry talked about her experiences in Borneo and Malawi; and Jennifer Taylor gave her very contrasting accounts of being in St Vincent and Grenadine and then Manchester.

Medical Woman | Autumn 2013

News/Events

Wales LTFT Training Conference The Wales Deanery held its Less than Full-time (LTFT) Training Conference on Wednesday 3rd July. Now an annual event it supports the 225 LTFT trainees in the region, and offers advice to trainees considering LTFT training. This year’s event was deemed the “most popular to date” by LTFT trainee representative Sarah Farmer, and came on the back of the deanery winning MWF’s “Most Family Friendly Deanery Award” for the second year in a row. The conference included an inspirational talk by Dr Emma Hill (author of “So you want to be a Medical Mum”) interactive problem-solving workshops also covered career issues, medical parenthood and LTFT timetabling. Dr Melanie Jones, past MWF President and Associate Dean for Careers and LTFT Training, also presented the fascinating results of her research on the lived experiences of specialist trainees – work and motherhood. L-R Dr Melanie Jones, Dr Emma Hill This was particularly poignant as Melanie retires this month after tirelessly providing a decade of enthusiastic trainee-focused support to those seeking advice on LTFT MWIA 29th International training. She will be greatly missed and we all wish her South Korea, July 31st to much happiness in her retirement.

WHO Update Clarissa Fabre

MWIA representative, GP in Sussex & Immediate Past President of MWF I attended the World Health Assembly in Geneva earlier this year; Dr Margaret Chan, the Director General of WHO, is truly inspiring. Progress has been made on Dr Margaret Chan the Millenium Development Goals, but much remains to be done, especially in reducing child mortality and improving maternal health. Dr Jhin Khim, President of the World Bank, was an outstanding guest speaker; results-based funding is one of the priorities of the World Bank, so that payment depends on delivery of outcomes. The Safe Childbirth Checklist has been developed by the WHO and the Harvard School of Public Health, funded by the Bill and Melinda Gates Foundation. It follows on from the Aviation Checklist and the Surgery Checklist which have proved very successful in developed as well as underdeveloped countries in reducing morbidity and mortality. WHO is inviting partners to participate in a collaborative field-testing exercise to explore implementation and usability of the Safe Childbirth Checklist in multiple settings. A report will be published in 2015. If you or your institution is interested, see: www.who.int/patientsafety/implementation/ checklists/en/index.html for more information, or email patientsafety@who.net Any projects will need to be self-funding. For a more detailed WHO report go to: www.medicalwomensfederation.org.uk/aboutus/news-blogs-competitions

www.medicalwomensfederation.org.uk

New to the MWF site – online payments! A simpler way to pay for membership & events! Congress Seoul, August 3rd 2013

Dr Helen Goodyear, Vice president Northern Europe,Past President of MWF

Six MWF members attended: past presidents myself and Clarissa Fabre, MWIA joint national co-ordinators, Julie Rutter and Sue Overal, Amanda Owen and Elizabeth Youngs. The Korean organising committee had put an immense amount of effort into this event and this certainly MWIA executive 2013- 2016. Front row (left to right) paid off. Shelley Ross, secretary general, Bettina Pfleiderer (President elect), Kyung Ah Park, President and Opening keynote speeches Afua Hesse immediate Past President. featured advancing the global Back row, Vice Presidents of the various regions. health agenda and the role of medical women. Fascinating and challenging talks were given on the environment, disaster and human health. Sessions looked at pregnancy and abortion, contraception practices amongst antenatal patients, sexual violence, disability, ageing, medical professionalism and many more. Both Clarissa and I presented in the ‘Life as a Medical Woman session’ (family friendly policies in NHS Trusts and newly qualified doctors wellbeing respectively). In Asian and African countries, female doctors have little time off after childbirth and flexible working/training is not established. Talks to take note of were on stress management and the meaning of rest for women doctors. In addition to the Scientific sessions there were Posters and E Posters. The 3 General Assemblies were lively with a closely fought Presidential election (2016-19), requiring a second vote won by Dr Bettina Pfleiderer. Resolutions were passed on surrogacy, female genital cosmetic surgery, education for women and girls, HPV vaccination promotion, maternal mortality, human trafficking, prenatal screening and protection for sex workers. Dr Kung Au Park, President (2013-16) and the new executive were installed, including myself as Northern-European Vice President. One of the most enjoyable aspects of the congress is networking with doctors from many different countries; Nigeria had over 160 female clinicians present alone! The social programme was superb. The highlight of which was a “quartet” of 13 male surgeons who provided one of the more surreal moments of the whole conference when they sang “There is nothing like a Dame” from South Pacific, in Korean! We do hope that you will join us for the 30th Congress in Austria in 2016.

Autumn Meeting

Aspects of Pain MWF Spring Conference 2013, Oxford Dr Helen MacMullen, FY2, Oxford Deanery

t was with much anticipation that I attended the MWF Spring 2013 conference, which this year took place in the historical city of Oxford. The event kicked off on the Thursday evening with a somewhat wet, but much enjoyed, guided tour of the famous landmarks of Oxford’s city centre, where members were treated to glimpses inside the beautiful colleges and entertained with interesting facts about Tolkien, Lewis Caroll and much more. This was followed by a delicious dinner at a city centre restaurant. On the conference day itself the atmosphere was buzzing, having attracted the largest audience I’ve ever seen at an MWF event, and a good representation from medical students through to retired members. The day started off with the most up to date functional MRI pain research from Professor Irene Tracy’s research group. She was unable to attend herself, but the findings were eloquently and expertly presented by Dr Vishvarami Wanigasekera, a last minute substitute. This year’s Dame Hilda Rose Memorial lecture, given by Dr Jane Moore, highlighted the high prevalence of chronic pelvic pain in the female population (1 in 6) and the importance of the teasing out of other, non-gynaecological contributory factors, both physical and psychological, in our management of this often debilitating condition. It was impressive to see such a high calibre of oral abstract presentations, especially from the two medical student entrants. The judges had a hard time choosing a winner! Congratulations to Nida Kalyal from Kings College London, who won the Elizabeth Garrett Anderson Prize with her presentation of the breast cancer awareness project that she has helped to implement in the London borough of Newham. The emotional aspect brought a tear to many eyes in the process. After lunch workshops ran smoothly and provided a good range of subjects. Professor Michael Sharpe’s talk highlighted the continuing debate surrounding Chronic Fatigue Syndrome vs ME and was highly relevant for today’s practising doctors. Dr Peggy Frith’s session on Athena SWAN awards proved that there definitely is a continuing role for the MWF, even in the modern world of supposed equality of the sexes. It also provided a lively discussion at Saturday’s Council Meeting. Professor Raymond Tallis rounded off the talks with his excellently laid-out philosophical argument in favour of the controversial issue of Assisted dying. The conference dinner in the magnificent Somerville college hall gave a perfect opportunity for catching up and talking with the day’s speakers. The after dinner speaker, Katherine Whitehorn, entertained us beautifully with her most appropriate agony aunt-esque talk on the current issues face by the older population! Many thanks to all involved with organisation of the event, workshop leaders, sponsors and those helping out on the day. It was an excellently educational and thought provoking event.

MWF Past Presidents enjoying the Sommerville formal dinner Front Row L-R: Dr Joan Trowell, Dr Clarissa Fabre, Dr Pauline Brimblecombe, Dr Fiona Cornish, Prof. Selena Gray, Dr Melanie Davies, Dr Helen Goodyear Back Row L-R: Prof. Wendy Savage, Dr Melanie Jones, Miss Sue Ward, Dr Fiona Subotsky, Dr Judith Chapman, Dr Gillian Markham

Medical Woman | Autumn 2013

Move Eat Treat

Dr Helen MacMullen and Dr Joseph Lightfoot – Director and Director/Co-founder of Move Eat Treat At the AGM in May 2013 MWF Council passed a motion to endorse the ”Move Eat Treat campaign”, a national movement which aims to increase the teaching in health promotion, nutrition, physical activity or ways to help facilitate lifestyle change to medical students. Drs MacMullen and Lightfoot describe the campaign below... If we had to sum up my medical education in one line we’d do so like this:

‘We’ve learnt a lot about disease, but we haven’t learnt about health’

This is not an isolated opinion, but is mirrored in both national reports and anecdotal, qualitative responses from today’s medical trainees. We call ourselves ‘health’ care professionals, but what do we actually know about ‘health’? It’s well documented that the current medical education, both undergraduate and postgraduate, is severely lacking in teaching of information essential to promote and support healthy living (nutrition, physical activity, stress management, sleep etc). It also does not equip us with the tools to enable us to confidently discuss these areas with our patients or to help facilitate change. Let’s put this into context within the current public health climate and have a look at some facts: Fact: the UK is facing a growing burden of obesity, physical inactivity and lifestyle related chronic disease. Fact: Globally, nearly one third of all adults do not meet the WHO minimum recommendation for physical activity. (Many doctors do not even know what this recommendation is). Fact: more than 40% of all cancers are potentially preventable by lifestyle modification. Fact: over half of all patients have never received lifestyle advice from their doctor. Our life expectancy has increased by 4.2 years over the past 2 decades, but our healthy life expectancy is not growing nearly as fast: The UK came 12th out of 19 countries of similar affluence in 2010 in terms of healthy life expectancy at birth. This means an ever growing population of people living with chronic disease. One could just ‘accept’ this chronic disease as ‘bad luck’ or ‘the inevitability of getting older’, or one could embrace the research that proves to us that we as individuals can make choices that optimise our health, not just in older age but across our entire lifespan. Whilst there are many factors contributing to the current state of our nation’s health, we believe the lack of education for health care professionals on lifestyle advice to be a particularly important one. After all, we are working within one of the most respected and trusted professional fields, are perfectly placed to support patients in this way and our potential influence is therefore www.medicalwomensfederation.org.uk

significant. And we are not just talking about doctors. Anyone who comes into contact with patients can make a difference. Move Eat Treat is a campaign and enterprise aiming to raise awareness of the importance of health promotion, the current lack of medical education in this area and also to put into place initiatives to start addressing the problem. Our vision is a healthcare system which doesn’t wait until patients become ill before it acts, but works to keep the population healthy – a true health service that is proactive rather than reactive. We are currently developing and supporting initiatives that will engage and empower healthcare professionals to deliver effective lifestyle advice. We are also building a network of like-minded individuals with the aim of increasing our success through the sharing of knowledge, resources, connections and ideas. Our current work includes: • Delivery of effective lifestyle teaching to junior doctors: We have been awarded funding from Health Education England to carry this out in the Oxford Deanery. Our plan is to train up other junior doctors to deliver the teaching in a peer education setting. •C reating an e-learning module on healthy lifestyle advice for University College London •A mbassadors and Advisors – we are continually developing our network of people interested in getting involved and helping our cause. • Regular Blogs and articles on the website • And more! Move Eat Treat has been lucky enough to receive the help and backing from numerous individuals and organisations. But now we need your help! Without our supporters the campaign is nothing. With you, we can make something happen. We can create a proactive healthcare system that helps keep people healthy. Visit our website to find out more www.moveeattreat.org References Global Burden of Disease data collected by the Institute for Health Metrics and Evaluation (IHME) in Seattle. Royal College of Physician’s: Action on Obesity Report. Major limitations in knowledge of physical activity guidelines among UK medical students revealed: implications for the undergraduate medical curriculum. Dunlop M., Murray A. Br J Sports Med. 2013. www.cancerresearchuk.org

Say it, Write it, Tweet it

“Say it, Writ Magazine Launch

@medicalwomenuk

Thank you for your comments on the magazine re-launch in Spring/Summer 2013. We hope to continue to improve it and appreciate your feedback. “I was pleased to receive the new Medical Woman last week, and enjoyed reading it. You must all have put a lot of work and thought into updating its look.” Dr Yin Ng, MWF Nottingham Local Secretary “Just wanted to say how great the new style Medical Woman looks and reads. REALLY well done it’s FABULOUS.” Dr Caroline Sheldrick, MWF Ipswich & Colchester Local Secretary “The new look ‘Medical Women’ is a compelling and inspiring read. Apart from its startling and beautiful cover, its lay out is excellent - for both a digital and hard copy read. It covers topical subjects in the NHS, practical and current issues of interest , controversy in the form of debate, science in an easy and digestible manner, top tips and global experiences! No where else will you get this breath of information for a medical woman at any level or age. The editor and the editorial team should be warmly congratulated on this excellent production!” Prof Parveen Kumar, MWF Vice President “I have just spent a happy hour leafing through the spring/summer issue of Medical Woman! Wonderful! I just wanted to congratulate you on this effort. Clearly a huge amount of work so I wanted you to know it has been worth it. Can’t wait for the next issue!” Narciss Okhravi, Consultant, London r Una Coales @drunacoales New Medical Womens Fed magazine now out! Well done editor @DrSaraK @medicalwomenuk. D Full of great articles+apps! Suzanne Reilly @suzreilly @medicalwomenuk @drsarak Magazine looks great! C of Psychiatrists @rcpsyc Just had a press release from @medicalwomenuk about their redesigned magazine R Medical Woman http://bit.ly/12McdtbWe like the new look!

Spring Conference Zay Jawad @znbjwd “Is ManFlu Really The Worst?” - very interesting presentation at #MWFConf13 ! S @owlette22 #MWFConf13 #aspectsofpain - can each member resolve to recruit another one by 8/11/13 Kim @ktolley1 Great to be at the @medicalwomenuk conference today speaking on medical ethics for the GMC #aspectspain S.Cooper @DrSACooper Learning and being inspired by a room full of awesome kickass women #aspectsofpain S @owlette22 At #mwfconf13 learning about #aspectsofpain - enjoying the day Zay Jawad @znbjwd Making the final preparations for my speech tomorrow at @medicalwomenuk ‘s Spring Meeting! Excited but nervous... #meded Echo @moorlandsmrs @medicalwomenuk im also on my way, looking forward to informally socialising. Less keen on formal socialising!

Other MWF @medicalwomenuk @TheWomensRoomUK Our Honorary Secretary will be on Sky News at lunchtime talking about #Keogh, very exciting! :) MJ Careers @bmjcareers Why are there so few female specialists in media? BMJ Careers gets some answers from B @medicalwomenuk & @tamisky_says http://bit.ly/10A9H9Q

Medical Woman | Autumn 2013

Say it, Write it, Tweet it

te it, Tweet it” SOAPBOX SOAPBOX SOAPBOX SOAPBOX What is holding women back? Dr Mona Kooner, GP, Kingston I have now been a doctor for 25 years. I can see that medicine has both changed for women and how it has not. Girls are trouncing the boys at intake level, outperforming them at getting the exam results. However, look at the higher echelons; Consultant level, Professorial roles, GP partnerships and political roles – women still are not well represented. Of course there are some but they tend to be exceptions. The glass ceiling has been replaced by the glass elevator; whereby men seem to be promoted more easily. What is happening along the way? The main key to success, particularly in the medical field, is hard work – putting in the hours. Girls are good at this. We continue to work hard but in our 30s and 40s other demands are made on our time. Relationships and family commitments have a disproportionate effect on our careers compared to that of our male colleagues. There are two main reasons for this. 1. Women are still the main carers in society and this means having less time for work as family [be they children, husbands or aged parents] need looking after. 2. Women are often not as ambitious as men and do not promote themselves as effectively. They tend to wait to be offered new roles or in the world of business – pay rises, rather than put themselves forward and they do not network as effectively. Looking back on my career I made many mistakes. The big one that most women make is the belief that ‘we can have it all’ and being ‘good at guilt’ we feel we should ‘do it all.’ The truth is, it is essential to learn to delegate and prioritise. When Sir Terry Leary’s [the Chief Executive of Tesco for 25 years] GP wife was asked how she managed to bring up her children and continue working, her answer was enlightening. She spoke of having the same curtains for 30 years and of sometimes feeding her family ‘chilli con carne from a tin’; she prioritised! So ladies – prioritise, share and delegate! Share the child rearing and the household chores and cooking. The best way to do this is to make a list; an ad hoc way will always lead to the woman doing the lion’s share. Don’t just share it with your man but with your children as well. Your children can learn to put their clothes away and share simple household chores. If guilt should raise its ugly head, remember that despite much research, studies have not

been able to show that the children of working mums suffer in any way while there are reams of evidence that show that non involved fathers have a detrimental effect on the behaviour of teenage boys and the self esteem of their daughters. Teamwork is important at work we all know but equally at home where your team should include people as varied as your partner, nanny, kids, neighbour etc. Be proactive – always offer to do things for others such as picking kids up; you never know when you may need a favour returned. Be patient and be prepared to have things less than perfect – and I am not just talking about when children do tasks. So often I hear comments from women that they would not dare let their husband or partner do a particular task because it would not be done properly. We are our own worst enemies when we think like this. Just remember that others need the practise! Networking – talking to others is what lubricates societies. It is a two way process – you help those you meet and learn from them. It is good for the soul and not to do so can leave you isolated. As many important decisions are made in informal chats at Practice meetings you can easily end up sidelined if you are not careful and rush off home straight after work. Be aware of your professional image. I felt in the past that I was extremely lucky to be doing a job that I loved and bring up a family. That was the wrong image to project –thankful and lucky. My male colleagues projected the opposite – that the Practice was lucky to have them! Lastly value your career. Medicine is the most sought after profession in the world. So many want to be doctors; not to make the most of the opportunity we have is almost criminal. Remember husbands and children can all leave, our roles change throughout our life but the most enduring of all roles is that you are a doctor. In summary for a successful career prioritise and delegate as much as possible. Make sure you have your ‘team’ – you can’t do it all. Most importantly aspire to heights. When it comes to your career do that ‘unfeminine’ thing – dare to be ambitious! And when you get there remember that Madeline Albright, the former American Secretary of State, said “There is a special place in hell for women who don’t help other women!”

If you have any burning issues to get off your chest, or news to share, then we’d love to hear from you. Contact us: @medicalwomenUK | MWF, Tavistock House North, Tavistock Square, London, WC1H 9HX admin.mwf@btconnect.com | 020 7387 7765 www.medicalwomensfederation.org.uk

TwitterView

Twitterview with Dr Helena McKeown – Portfolio GP Principal @helenamckeown

Q: @helenamckeown

When did you join Twitter and how often due you check it?

A: @medicalwomenuk

Bns Sheila Hollins who can see when she is best person for a job & goes in, gets it & makes a success of it & cares 4 family

I joined Twitter 14.9.09 & check it in the early morning, at lunch & after Surgery, more at weekends

Q: @helenamckeown

What attracted you to medicine?

A: @medicalwomenuk 2004 4th baby; nationally elected to RCGP Council & GPC; Chair of Community Care Cmmttee & (ex-officio) member BMA Council

my best friend’s mum next door was a GP & I admired her. Did want to do altruistic work abroad initially tho

Q: @helenamckeown

A: @medicalwomenuk

How did you become involved in GP politics?

A: @medicalwomenuk

I was a single parent having to pay for childcare to go out at night on-call; without even tax relief

What has been the best year of your career and why?

How do you keep up with your family and friends? Catching 2 friends b4 prizegiving today but generally friendships have suffered; Mum’s on @dollymckeown & FB; son’s @BathSU

Q: @helenamckeown

How do you manage your multiple roles?

A: @medicalwomenuk

V helpful husband logistical planning & delegation. Kitchen Fmly Calendar; more child minding hours than reg used; named taxi

How did you end up becoming a Councillor (in Wiltshire)?

A: @medicalwomenuk

Can do much I can’t as GP 4 public hlth & ppl eg moved pt fr 1 home 2 another 4 frnds 2 visit & take him out

Q: @helenamckeown

What uplifts you?

A: @medicalwomenuk

Praise about our children (esp if been kind) or after therapeutic singing lesson with @wheresmymilk & travel

What has been your greatest achievement?

A: @medicalwomenuk

Raising happy children as initially a working single parent then with husband & an integrated step-family; All credit to them

Q: @helenamckeown

In your view, how can we make GPC more representative of the profession?

A: @medicalwomenuk

all of us who can shld mentor&encourage&enable women to stand & feedback if at 1st they don’t succeed http://www.pulsetoday. co.uk/views/opinion/poor-remuneration-fear-of-failureand-our-current-voting-system-are-all-holding-female-gpsback/20003033.article#.Ud2Xu_nCaSo

Q: @helenamckeown

What has been your favourite role to date: GP Partner, Salaried or Locum?

A: @medicalwomenuk

despite relentless deprofessionalisation of docs I recommend UK GP partnership to FY2s -1 of best career choices 4 females

Q: @helenamckeown

What are your feelings about the recent GP Contract changes?

A: @medicalwomenuk

the imposed targets may allow us to nearly maintaining income likely to have unintended consequences eg reducing continuity

Q: @helenamckeown

What are the issues affecting female GPs in 2013?

A: @medicalwomenuk

Being able to give the quality & continuity we want; deprofessionalisation; getting equal pay & status to male GPs; homelife

Q: @helenamckeown

Who/what has been your biggest inspiration?

What do you do to relax?

A: @medicalwomenuk

Read, currently Faulks ‘A Possible Life’; watch, recently ‘House of Cards’ on Netflix; book, travel

Q: @helenamckeown

Name someone you love to follow on Twitter and why

A: @medicalwomenuk

@clarercgp - always there esp 1st thing ; commenting on same as I read & hear on @BBCr4today & replies to me

Q: @helenamckeown

As a woman in the medical profession, have you experienced discrimination?

A: @medicalwomenuk

Was once told at a national residential meeting ‘I should be home with my children’

Q: @helenamckeown

With the rapidly changing NHS + university system, should we encourage our daughters to follow a career in medicine?

A: @medicalwomenuk If daughters want to help ppl? Better to emulate Jamilla Abass; didn’t get into Med Sch, went on to invent @mfarm_ke 4 farmers Q: @helenamckeown What advice would you give a female medical student/junior doctor about developing her career?

A: @medicalwomenuk Always take FT & only reduce if nec Seek a mentor(s). Be prepared to do an unpopular job & then do it well.

NB. Some words are abbreviated as tweets are only 140 characters long.

Medical Woman | Autumn 2013

Women at the Top In this feature we profile medical women who have demonstrated reaching a senior position within medicine...

Women At The Top Professor Jenny Higham – Consultant Gynaecologist, Vice Dean & Director of Education, Faculty of Medicine, Imperial College

Name: Professor Jenny Higham Born: Warrington Lives: Central London Medical School: UCL Year Qualified: 1985 Specialty: Gynaecologist, Senior University Management & Leader of two Undergraduate Medical Schools First Ambition: To qualify!

Professor Jenny Higham is Vice Dean and Director of Education in the Faculty of Medicine at Imperial College. She is also Senior Vice Dean at the Lee Kong Chian School of Medicine in Singapore – a joint Medical School of Imperial College and Nanyang Technological University in Singapore. In addition, she sits on a number of external Boards. She remains research active with current interests including the use of advanced simulation in medical education and she continues to have clinical responsibilities as a Surgical Consultant Gynaecologist at Imperial College Healthcare NHS Trust.

Other Career Related Interests/Roles: Vice Dean & Director of Education, Faculty of Medicine, Imperial College Senior Vice Dean, Lee Kong Chian School of Medicine, Singapore Board Member, Health Education North West London Board (LETB), Governor, Chelsea & Westminster Hospital NHS Foundation Trust Non-Executive Director, West Middlesex University Hospital NHS Trust Board Member, Brighton & Sussex Medical School Joint Board Challenges along the way: Keeping multiple balls in the air; having diverse responsibilities – challenging but also the great attraction of a multi-faceted job; a career that has unfolded through many stages – it is fantastic to re-invent yourself from time to time but requires considerable effort! Rewards of your role(s): Variety and status; working with great colleagues; still being able to help patients either directly or through better training and education of others. Inspirations/influences: Continuous interaction with incredibly bright students is a real privilege. Also having a full life beyond work, reinforced by having a non-medical husband and 3 kids with big and diverse personalities! Quotas for senior positions for women in healthcare – yes or no? No Advice Do’s: Do expect to work hard; do deliver what you promise; do treat everyone you can with the respect and care – my world is made up of varied supportive teams and I consider it only fair to invest in their futures too. Don’ts: Don’t let people down – if you’ve said you’ll do it, then do it. How to get there: Volunteer and take opportunities; be persistent; turn up; try to get on with people; of course learn to say “no” but most of my success is based on when I said “yes”!

www.medicalwomensfederation.org.uk

Pension Tension

Pension Tension Dr Mark Porter

Consultant Anaesthetist, West Midlands, Chair of Council, BMA

hanges to the NHS pension scheme will result in NHS staff seeing an increase to their normal pension age, higher contributions and an end to the current final salary scheme from which most doctors benefit. The BMA campaigned hard against these changes, aiming to demonstrate to government the real harm that would be done to doctors across the profession. We called the campaign ‘Pension Tension’ to reflect the anxiety and anger felt by many doctors. Much of our campaigning fell on deaf ears. Parliament is responding to an ugly mood in the country that seems to say that if private sector pensions are rubbish then public sector pensions should go that way too. Along with the other health and public service unions, the BMA could not stop Parliament doing this. In a survey of almost 4000 of our members at the end of 2012, across all branches of practice, over one fifth listed changes to the pension scheme as the single most important issue facing the profession. From juniors to consultants, the changes will affect all doctors, and inevitably some will be affected more than others. Junior doctors in particular have been hard hit by the changes. They will have to pay more overall in lifetime contributions and work longer, to receive a pension that is still less than they would have received under the old scheme. This is a common experience in private industry, but a new and very painful experience in the public service.

Example: A 25-year-old junior doctor who goes on to follow a consultant career path could have to pay an additional £137,000 in lifetime contributions and not take their pension until the age of 68. Their annual pension at 60 will be considerably less under the new scheme and will be based on career average earnings rather than final salary and received for fewer years. Overall, a 25-year-old junior doctor could be paying around 50% more into the scheme to get around 30% less out of it.

There is some comfort for part-time workers. Larger numbers of lower paid staff members (usually female) may benefit to a greater degree through the career average scheme, redressing the relative disadvantage that some female staff experience in a final salary scheme. Given that women tend to be less well paid than men and pay progression is not so good on average, (a matter of some shame to the profession generally), women will not lose quite so much. It’s the unfairness imposed by Parliament that so upsets doctors. 12

Overall a doctor is paying double the contribution of the average civil servant on the same salary. Being in a uniformed service means being able to retain a normal pension age at 60 or below, but not if you happen to be a paramedic, a nurse, an intensive care doctor or a GP. A typical consultant could have to pay an additional £100,000 in lifetime contributions and work an additional seven years, until the age of 67, to receive a full pension. Overall, a 40-year-old consultant could be paying up to 50% more into the scheme to get around 7% less over the course of their retirement. Likewise a GP could be paying up to 50% more into the scheme to get around 13% less out of it. However, despite all of the changes and the disproportionate impact that the government’s policies will have on doctors, most independent financial advisers would still advise doctors to remain a member of the NHS pension scheme. The scheme still offers benefits that are impossible to purchase on the open market at the same cost, and as such the newspapers will continue to carp and complain about it. The BMA’s main lobbying work is now directed at the post2015 contributions levels – we believe that they must be structured to reflect the end of the advantage that we have gained in a final salary scheme. After all, why should doctors pay a higher proportion when the pension is based on the same proportion of pay as everyone else? The early indications we have had is that the government is beginning to understand this: the secretary of state replied to us about this with a commitment that any talks about post-2015 contributions will be fair to all parties. We will now make sure that the government is held to account on this. For more advice see www.bma.org.uk/practical-support-atwork/pensions and for more about the pension changes see www.bma.org.uk/working-for-change/negotiating-for-theprofession/industrial-action-pensions. Medical Woman | Autumn 2013

TopAPPS For Medical Women

Top Apps

by Dr Sara Khan, Editor of Medical Woman Mediquations – This is an app useful for work

– whether on the wards, in theatre or at your GP surgery, it doesn’t need an internet connection and was invented by an American 3rd year medical student! It ensures you calculate everything from a BMI to a medicine dosage correctly.

Dropbox – One of my life essentials! It is the self-titled “magic pocket” of the 21st century. Just like a flash drive, it allows you to hold up to 2 GB of data. Unlike a flash drive, you can always access it as it uses cloud technology to let you share information across multiple mobile phone devices, computers and tablets. The Medical Woman Editorial team use Dropbox to produce this magazine for our readers! Pocket – Another app I can’t manage without, this allows you to save those articles you come across online to read later. The article is then sent to the user’s Pocket list (synced to all of their devices) for offline reading. Pocket removes clutter from articles and allows you to adjust text settings for easier reading.

Instagram – This is an online photo-sharing, videosharing and social networking service that enables its users to take pictures and videos, and then apply digital filters to them making them look prettier, in a square shape similar to Polaroid pictures. Here’s one I made earlier! (Beachy Head, Eastbourne in the spring.)

DocsToGo – View and edit files whilst on the go on your mobile or handheld device including Microsoft Word, Excel, Powerpoint, Apple iWork documents, PDFs and HTML. The app easily syncronizes over WiFi; users simply install a desktop file management application and set their preferences. DocsToGo will manage folders or individual files.

Patients’ and Doctors’ Safety:

Can women change the culture of the NHS?

The largest body of women doctors in the UK looks forward to meeting you!

Medical Women’s Federation

Autumn Conference 2013 Friday 8th November 2013 – Grand Connaught Rooms, Covent Garden, London Dame Fiona Caldicott, Chair of National Information Governance Board The Dame Rosemary Rue Lecture: Prof Bhupinder Sandhu OBE, Professor of Paediatric Gastroenterology Prof Vivienne Nathanson, Director of Professional Activities, British Medical Association Dr Vicky Osgood, Assistant Director of Postgraduate Education, General Medical Council

Workshops: Career Guidance • Learning to Coach Whistleblowing Safety • Tax and Pensions You still want more? How about a social programme excellent for networking?! For more information on the conference and all other MWF events please visit:

www.medicalwomensfederation.org.uk or scan the QR Code. www.medicalwomensfederation.org.uk

Debate: Debate

This Issue’s Conversation:

“Is there resentment or preferential treatment regarding maternity leave & other privileges for those who have children?” The title for this edition’s debate emerged after MWF President Dr Fiona Cornish featured on Radio 4’s Women’s Hour alongside Anna Soubry, MP and Health Minister, to discuss the widely reported comments she made about part time women doctors in the House of Commons. We received an anonymous response from a female doctor regarding the impact of part-time female staff in the NHS and felt that a debate was needed...

Letter from Anonymous

heard the show on Thurs 13th with Anna Soubry MP & Dr Fiona Cornish re: part-time GP hours & the cost/impact of this, with fury and exasperation. As a female health professional working in the NHS who does not have children, it is clear that child free staff are blatantly discriminated against in work. Unlike Fiona, I have felt exasperated and burnt out for years, through doing no only my job, but that of at least one other colleague, who is on maternity leave for a year (usually), & at times more than one other college. I too hope to work through retirement, but sadly I do not have 6-12 months off in my career, & no additional holiday, pay, or tax benefits for doing the work of at least two people. Nor can I afford to reduce my hours as I do not receive any free money from the state. The increased levels of stress in school holidays when staffing has been known to drop by half (although the load never does), & the assumption be female staff you are entitled to always have every holiday off with preferential treatment over any child free staff, adds to the resentment. Following maternity leave staff return to work

2-3 days which does not always cover the service adequately & impacts on the quality of the service offered. Given the vast majority of staff in the NHS are female and of child bearing age (nurses, allied health professionals & now medics), I would not recommend working for public services unless you are planning a family where you are able to make full use of all the benefits, while your childfree colleagues work themselves into the ground doing your workload as well as their own. While this is a bigger problem in the public sector with high numbers of female staff, I also know of others in the private sector who feel the same. There is a large wave of resentment & bias towards maternity leave & privileges, yet this remains a taboo subject that is never discussed. I have not given my full name & wish to remain anonymous as I need my current job & do not want to risk any hostility at work. I would be very interested if this subject was addressed on women’s hour which seems to regularly address child & family issues; yet childfree is becoming increasingly common. An alternative view of the impact of part-time female staff in the NHS. Some of us feel the real impact.

MWF Statement MWF believes that all organisations should have robust work force plans to ensure that all staff work in a safe, supportive and productive environment. Workforce plans should take into account predicted maternity leave, long term sickness absence, sabbaticals and other roles and responsibilities e.g working for Royal Colleges, CCG roles, Deanery commitments amongst others. All of these can have an

impact on the safe and effective working of teams. Taking on these responsibilities has the same impact on members of the team as someone taking maternity leave. Both are necessary; one for the medical profession’s progress and the other for society’s progress. It is time that employers recognise this and plan their workforce accordingly. A safe, supportive and productive environment is everyone’s right.

Medical MedicalWoman Woman| Autumn | Spring 2013

Debate

Discuss... Dr Farah Jameel, Locum GP, Chair of South Thames Regional BMA Junior Doctor’s Committee There certainly is resentment but this comes from poor medical staffing and HR policies. Where a 9 or 10 man rota is worked understaffed. It’s simple really; if there’s a vacancy – fill it. Lumber on the extra work to the rest of the team and of course there’s resentment. Who likes being abused as a work horse? There’s only a certain amount of work we as clinicians can safely carry out at the end of the day. Specific situations like pregnancy and long term sickness is something a medical staffing dept has enough notice off and can plan and fill a rota gap way in advance. Any resentment isn’t towards an individual but more the organisation with poor work ethics who think its okay to just leave rota gaps unfilled. This is just unacceptable and unsafe but unfortunately still quite common place.”

This is an online conversation on the topic within Tiko’s GP Group on Facebook, the UK’s largest online social media group of GPs:

sabbatical for a College role or a Deanery commitment, is better workforce planning – sadly, this is probably a rather distant utopia!

Alexandra Fulton As a mum to a 1 year old, I’d rather take holidays as I used to-outside of school holidays-less children around and cheaper! My colleagues need the holidays, but I get first dibs on the rest of the year. Plus in GP world (and hospitals I would expect!) a lot of clinics/spots are at an all time low over ‘summer holidays’ so working them is often less stressful!

Asim Safdar Is the increasing no of women in medicine possibly something to do with this? Naturally they’ll want kids and take breaks. Do med school deans need to equalise the numbers a bit? Hypothetically if the top candidates were all girls for example where would that leave us as a workforce?

Arefa Isat-badat Before I had my Children I was the only dr at my practice who didn’t take leave during school hols – I more or less had first dibs for leave rest of the year and was allowed few weeks of in ramadan. I now have children and they will be starting school in September so likely I will have to join the “school hols rota” where we all take turns at taking leave at certain times. Arefa Isat-badat Agree with Alexandra – would rather take leave outside of school hols Hannah Edwards before I had kids I would never ever go away during school holidays its way mroe expensive! would have been more than happy to cover those with kids . Sara Khan I think we should be able to take leave, within reason, when we want to... however there should be sufficient work capacity to allow for this in a way that is safe for patients and our colleagues who work when we are away. My understanding in general practice is that this really varies – some practices seem to prefer to save money and do cross cover, or simply cancel surgeries without replacing them; others use locums. It’s up to the partners in the practices really – personally I’m acutely aware of my own stress, and I’d rather manage leave with employing locums than bust a gut in order to have a bit more money... In the hospitals it’s quite different; a good friend of mine was exasperated last week because out of an 8 person O&G rota; only x3 were in! She developed an URTI and didn’t feel too good but there was no chance she would have let herself have a day off to rest. The key in managing things and keeping everyone happy I feel whether hospital or GP, whether its mat leave or a

www.medicalwomensfederation.org.uk

Sharon Hadley Organising rotas and shifts is extremely hard. It usually doesn’t work when there has been poor workforce planning In hospitals; most leave crises are due to poor forward planning and as has already been mentioned leaving places unfilled when people leave to save money and because HR is too slow to reemploy. I had 2 children and the nearest to a nervous breakdown I ever had was getting them cared for in the holidays. That said I did not feel I had any greater right to those weeks than other colleagues and most places I worked we tried to be fair when everybody wanted the same leave. In General Practice this is where it gets harder as being smaller although all the other stuff applies places are smaller and it is far more down to personalities. Young all female practices struggle as due to the number of weeks available it almost comes down to drawing straws. Resentment comes if people feel they are being abused therefore so long as a fair system is in place and it is worked efficiently rather than a first come first served approach things will be fine. Claire De Mortimer-Griffin I’m a locum. Holidays is when business is best. Helen Rainford As I don’t have children I have to cover my colleagues for maternity leave and am the only partner who has to work the entire school holidays and cover for the Dr’s who have children or partners who are teachers. It’s a very busy time as lots of people are away – I have my annual leave when the rota is better covered. We try to get locums but locums are very difficult to come by for some reason in Barnsley. As the rota organiser, which is a soul less and thankless task, trying to cover everything invariably means that those of us not away in school holidays just have to take up the strain! It’s just how it is!

Charity Spotlight

Wellbeing of women Wellbeing of Women is proud to be the charity partner of the Medical Women’s Federation, to improve women’s health through truly unique events and opportunities. We would like to involve you in our regional activities and connect you with our branches across the UK. We held our first very successful joint shopping evening at Hobb’s flagship store in Covent Garden on International Women’s Day. We hope that you will support us over the coming year and join us for more events like these.

ellbeing of Women is the charity dedicated to improving the health of women and babies, to make a difference to everybody’s lives today and tomorrow. We provide information, to raise awareness of health issues to keep women and babies well today. We fund medical research & training grants, which have and will continue to develop better treatments and outcomes for tomorrow. Since its founding in 1964, the charity has invested millions of pounds in research and training. Many of the developments of the last 50 years which we now take for granted – pain relief in childbirth, ultrasound scanning during pregnancy, IVF and cervical cancer screening, to name but a few – have been enabled through research funded by Wellbeing of Women. Put simply, since the charity was founded, every woman in the UK and indeed many worldwide, have benefited from our work. Despite the progress we have made, however, half of all women in the UK still experience an obstetric or gynaecological problem during their lifetime. In the UK, 17 babies die at or near birth every day, ovarian cancer kills 1 woman every 2 hours and 250,000 pregnancies will miscarry each year. We can change this with more top quality research and better health awareness. The challenge we face is that for the hundreds of applications we receive, we are only able to fund four or five projects. As one of our eminent researchers said, “There is no lack of ideas or expertise, just a lack of funds to make these projects possible”. Our researchers are currently working on projects to find a new way to treat ovarian cancer, by using viruses to target the cells. They are investigating ways to further prevent brain damage in new born babies, as well as improving our understanding of womb cancer, so new treatments can be developed. Our Baby Bio Bank, which is opening in September of this year, will enable faster research into the genetics of common pregnancy complications

and ensure a pooling of data to encourage collaboration and sharing of knowledge. It is set to revolutionise research into pregnancy complications and is the first of this kind in the world and will serve as an international resource to researchers. You can read more at www.wellbeingofwomen.org.uk Working in partnership we have achieved remarkable results. It is a very important way of maximising our resources and ensuring we have the best professional advice on using our funds, to make the biggest difference to women’s health. We have established partnerships with the International Federation of Gynaecology and Obstetrics, The Royal College of Midwives, The Royal College of Obstetrics and Gynaecology, The Royal College of Physicians as well as many corporate partnerships and trusts and foundations. We look forward to working with the Medical Women’s Federation to help improve the lives of women and babies, whilst having fun at the same time!

“In the UK, 17 babies die at or near birth every day, ovarian cancer kills 1 woman every 2 hours and 250,000 pregnancies will miscarry each year”

Medical Woman | Autumn 2013

Articles

Interpersonal Education Violence Programme Miss Jessica Roth and Miss Lucy Williams Year 4 Medical Students, Manchester Medical School The authors of this article are two medical students of a team of three who are spearheading the Interpersonal Violence Education Project at Manchester Medical School, in conjunction with St.Mary’s Sexual Assault Referral Centre.

“He was a nasty man, my first husband. Gave him 3 boys, but he used to force me to have sex with him. Made me feel sick”.

n 86-year-old lady told this story to a medical student on a busy Medical Admissions Unit. The reason I remember these words so clearly is because I was that medical student, asked to take a history to present it to my consultant. This patient was admitted with an exacerbation of Chronic obstructive pulmonary disease (COPD). She had also suffered the crime of rape, along with over 1200 victims per year in Manchester alone. The scenario rape victims find themselves in when disclosing sexual assault – be it to police on the street or behind the curtains in A&E – most strongly dictates their future actions. These actions may involve seeking follow-on services such as a forensic and medical examination, psychological support or just practical assistance as a result of sexual violence and help through the court process. If a disclosure occurs in a medical setting and a doctor cannot provide accurate information and a competent forensic examination, it is understandable that victims lose faith in the public service support system. This results in a universally poor outcome for the victim, and a perpetrator is free to rape again. This is a contributing factor to why a crime of a sexual nature is recorded every 6 minutes in Britain. As medical undergraduates, at no point does our university provide guidance on what to do when a patient discloses such information to us; despite Manchester being home to St Mary’s flagship Sexual Assault Referral Centre (SARC), one of 46 centres in the UK. A quick survey of our peers at other UK medical schools presents a similar shocking picture. Our group of three Manchester medical students decided that it was simply not good enough that thousands of newly-qualified Foundation doctors could not competently deal with recent or historic rape victims. We therefore embarked on our Interpersonal Violence Education project in conjunction with St Mary’s SARC and Manchester Medical School. www.medicalwomensfederation.org.uk

From September 2013, Manchester Medical School will pilot the ‘Interpersonal Violence’ teaching programme, incorporating teaching on elder abuse, domestic abuse, rape and sexual assault: • Problem-based learning cases will supplement and enhance our core learning modules. • E-learning lectures delivered by the Clinical Director of St Mary’s, Dr Catherine White will provide a comprehensive overview of clinical, legal and ethical issues. • Manchester Medical School plans to include examining core forensic skills in forthcoming OSCEs. We have been very encouraged by the support we have received from medical organisations since launching the project, including the Medical Women’s Federation and the British Medical Association. The support we received at the BMA’s Annual General Conference 2012 means that it is now BMA policy for medical schools in the UK to teach their undergraduates aspects of forensic medicine, including referral pathways to SARCs like St Mary’s. Unfortunately, not all of our conversations have been positive. A peer at a recent conference told us there was no point in pursuing our motion as ‘hardly anyone gets raped’. While we have had some challenging conversations since the project started, we do not want to shy away from them just because they are difficult. Indeed, the more we have encountered stereotypical and stigmatised attitudes, the more insight we have developed into understanding the roots of myths amongst our fellow students. This insight and greater understanding, we hope, will help us to continually improve the project, and therefore contribute to it’s efficacy. We want our generation of doctors to be open-minded, nonjudgmental, and equipped with the knowledge needed to help patients made vulnerable by horrific experiences that were not their fault. If our project continues with the momentum it has gained, within a few years the Manchester teaching programme on Interpersonal Violence may be distributed to universities throughout the UK and even internationally. 17

How I got here

How I Got Here Professor Parveen Kumar Professor Praveen Kumar is a Lecturer, Consultant Gastroenterologist based at Barts and London Hospital and MWF Vice President. Interview by Dr Sajini Wijetilleka, ST3 Endocrinology & GIM, London What made you choose medicine as a career?

Medicine is a fantastic career – it encompasses the two things I enjoy most, science and caring for patients. When did you decide to pursue a career in Gastroenterology?

I decided to train in gastroenterology about 3 years after qualifying. I wanted to become a physician as it gives the opportunity to pursue a clinical question to the end... almost like a detective story! I also enjoyed the variety of working on the wards, in clinics and in endoscopy, It is very much a team working speciality. How did you move into academia?

I was always interested in academia; at medical school, I did a BSc in physiology which was unusual those days as only four students per year were selected to do an intercalated degree. This year gave me the opportunity to think about a topic in detail and also do some research, which I enjoyed immensely. I was subsequently invited onto the Barts Gastroenterology team for my training; this was excellent. Research was integrated into the registrar training, along with general medicine (being on take, working on the wards and clinics), gastroenterology and endoscopy training. Describe your average day pre and post-retirement?

Well, it doesn’t seem to have made any difference, except that I am doing different things. Pre-retirement, I woke at 5.30am and was at work by 7am. I ensured I got some work done prior to everyone arriving at work around 8ish. For a long time, I was working at three hospitals; Barts, the Homerton and the Royal London, doing gastroenterology and general medicine and acute take at two of them. I was also asked to take on the Directorship of the new Postgraduate Department which involved setting up a new department and bringing people together. Post-retirement, I wake up at the same time but have the luxury of getting out of bed slightly later. I have been retired from the NHS for three years. I still work as Professor of Medicine and Education at Barts and the London school of medicine and Dentistry, Queen Mary, University of London; This is mainly in an educational/teaching/mentoring capacity. I have my own group of students to tutor regularly and teach on the wards; I 18

lecture and teach clinical skills to years one to three. I am on several committees. A few years ago I started the first MSc in gastroenterology in this country and I am currently the vice chairman. I am an MRCP PACES examiner/chair for the Royal College of Physicians. I also examine for the MBBS in the UK and abroad. Because of our textbook, Kumar and Clark’s Clinical Medicine, Dr Clark and I are invited all over the world to lecture and teach on the wards This gives us an opportunity to see medicine around the world. It is also a great pleasure and a real privilege to be able to teach medical students and doctors in other countries; I must have visited at least 8 or 9 countries, on all continents last year. I was invited to join a group in a non-NHS clinic. This has made me appreciate the differences between the NHS and private practice. In the private sector, I have much more time to see patients and solve complex problems – a real privilege having time! Whilst I abhor the idea of charging for medicine, working privately allows me to work at my own pace, give my best to my patients and keeps me up-to-date! I am a trustee of various charities, such as the Tropical Health and Education Trust (THET), Southern African Consortium for Research Excellence (SACORE), and currently the chairman of the BUPA Foundation which supports research initiatives. As President of the Royal Society of medicine over the last 2 years, I set up new initiatives such as on Global Health along with a colleague. I am still asked to do things for the BMA, I was President a few years ago, and NICE (I was a non-executive director). And recently, I have just become the Vice-President of the Medical Women’s Federation – a role I am very much looking forward to. Becoming one of the first Asian female Professors was an achievement. How did other colleagues react at the time?

My colleagues loved it; they have always been very supportive. I was the only female on the Barts Gastroenterology team for twenty years! This didn’t really worry me; in fact it was probably an advantage Do you think females of ethnic minority extraction have it easier compared to during your time?

Definitely – females of black and minority backgrounds are the norm these days. There were about eight or so female Medical Woman | Autumn 2013

How I got here

students in my year at medical school and I was the only ethnic minority. The women all ensured that we worked harder than the male students to ensure we didn’t let the side down. Have you faced any obstacles along the way?

I was fortunate to have had supportive supervisors and friends so this hasn’t been a problem. What advice would you give a female doctor about combining a teaching, research and clinician career?

This is a difficult act to balance but absolutely fantastic if you can manage it. At different points one aspect may overshadow another so it’s important to prioritise and be sensible in order to get this right. I enjoy the variety; each aspect brings different challenges.

What is the future of medical textbooks in an age of digital publishing?

Whilst I own a Kindle myself; there is nothing like annotating a handheld text when learning. Since the 5th edition, we have had downloadable versions of the book available when you purchased a book. A US web-publisher have our eighth edition as their only European textbook for medicine I their list of interactive books on line. Does it feel like a big responsibility to be the definitive word on a subject?

What are your top tips for maintaining work/life balance?

It’s scary! We take great care working on each edition; ensuring that sentences are free from ambiguity. We strive for clarity, ensuring readers are aware of which treatment to use, when and why. Kumar and Clark is also used in the legal context; courts use it to search a consensus for medicolegal reports to see which treatments were used at the time of the event.

Have good support at home. I was extremely fortunate to have had a very supportive husband who was also a consultant. Always remember your family comes first – work very hard when you are at work but ensure you have fun too.

Why do you think the rates of clinicians leaving the profession before retirement has increased compared to when you were starting out?

What are your top tips for doctors thinking of retiring?

Think of what you want to do in the future well before retirement. We are all living longer and are healthier so there will still be lots of things one can contribute to from past experiences. I am still very busy. It’s worth exploring all the options before you retire; perhaps developing other interests and hobbies. Grandchildren are another joy – I enjoy their enthusiasm and handing them back to their parents when I’m done with the responsibility. What’s been the key to your success as a clinician and as an author?

As a clinician, my success, if it is success, is down to continuous hard work, remaining conscientious and committed to patients. As an author – again, incredibly hard work. Weekends and summers often spent writing indoors whilst your family and colleagues are outside enjoying the sun. You really have to be very disciplined as an author; apart from the writing, the worst is checking and rechecking every detail prior to publication. However, don’t feel sorry for me... I have always had great fun! Which developments in the physician’s field do think are most significant since you started writing and editing?

I sometimes cannot believe the advances that have occurred since I started the book. For example, the discovery of H. Pylori and its’ eradication has totally changed the management of peptic ulcer disease; very few operations are required now and only for complications. Monoclonal antibodies have also expanded our range of therapeutic options e.g. for inflammatory bowel disease – their scope is endless. Cardiology has changed beyond recognition, and of course, with all the new technology, we now have super imaging. www.medicalwomensfederation.org.uk

Modern working patterns and the prevalence of shift work has resulted in a loss of camaraderie between colleagues. The team structure and continuity of care has vanished; when I was a junior doctor, my colleagues lived onsite. We worked together and ate together. The on-call team was in the ‘mess’ ready to answer questions and offer support when things got difficult; juniors don’t have that now making the working experience less satisfying. Documentation and bureaucracy, with a focus on targets can lead to juniors concentrating on these to the detriment of other aspects, namely enjoying work and learning on the job. There has also been some loss of respect for doctors on the whole; I feel the media and TV soaps have played a part in this by portraying doctors behaving badly. Whilst it’s been quoted that ‘to err is human – one can only be accurate 95% of the time’; I feel it’s important to be honest to yourself. Do admit when you don’t know the answer and find the evidence for the correct answer; this way error will be minimized. If you were thinking of applying to medical school now, would you and why/why not?

Yes, I would still apply to medical school now. There is that excitement of medicine that overtakes me... solving a problem with the symptoms, investigations, diagnosis and making the patient better. However, I am not sure if I would get into medical school now... it is all so competitive! Five Things You Need to Become a Successful Academic

1. Curiosity 2. Hard Work 3. Retaining and refreshing knowledge 4. Enjoyment – always make time for fun 5. Family support 19

Personal Stories

Grieving the child I long for A personal account of my journey through infertility and depression Dr Angela Nelmes, Core Medical Trainee, West Midlands

Infertility in context Infertility affects approximately one in six couples in the UK1 Many of us will encounter women, and indeed men, who are, or who have been affected by infertility. Many women hope for and expect to have children. It is a milestone, a choice in our lives we expect to be able to make. We may even assume that for those without children childlessness is their choice. Often, for women longing for a child, the desire runs so deeply that failing to achieve or maintain pregnancy can cause harrowing emotional pain and grief.

The start of my journey

work harder and I found myself constantly frustrated. I wasn’t who I wanted to be at work or at home. I sought my GPs advice but declined medication in favour of continuing to try for a child, after being told I would have to restart contraception if I were to take antidepressants. I was advised by colleagues to keep both my depression and fertility problems silent for fear they would affect my future career prospects. I was offered, and subsequently accepted, counselling, which led to a temporary improvement in my mood and level of functioning, but it was short lived. Six months later, I developed a severe depression and planned to end my life. My fear of the judgement of healthcare professionals in my local A&E department meant in spite of my symptoms, I avoided seeking urgent medical help. It was only through God’s Grace, the support of my husband and close friends that I was prevented from harming myself, and escorted to my GP the next day.

Like most doctors my life is busy. We decided to start trying for a child in 2010, just as I was completing my F1 year. But often ‘trying’ was squeezed in around shift work, courses, conferences, portfolio, audits, studying for exams, housework, friends and just trying to keep up a hobby or two. Looking back, this was far from ideal, and certainly may have contributed to our failure to conceive within ‘normal’ timeframes. I felt under pressure to have both a good working and family life, and I dared not tell colleagues of our efforts to start a family for fear of being branded as less committed to my career. Unfortunately this is a situation many working-women face. In the first few months I was quite relaxed and tried not to obsess about our failure to conceive. As time went on, friends started trying, falling pregnant, had their children and it became apparent that something was wrong.

Learning to live again

Failing hope

I don’t know whether I will fall pregnant, I don’t know if I will ever have a family. And that scares me. But I do know I have a support network that can get me through, whatever the eventuality. I hope that through telling my story I can help those suffering from infertility by increasing awareness of its emotional effects, and the importance of recognition and management of depression in these women. I hope to inspire others to seek help and support. Let us break the stigma and ease the pain of grieving the child we long for.

Each month I found myself staring once again at a negative pregnancy test and as the months went by I started to feel a deep loss for each child that could have been. I started to doubt I would ever fall pregnant, that I would ever be a mother and even my value as a woman. I dreaded being asked if I had children or if I planned to. Should I brush it off with a vague ‘maybe one day’ or reveal my vulnerability and tell them the whole story? Visiting friends with children became harder and I found myself becoming more and more isolated. I felt so utterly alone.

Loss, depression and despair The recurrent pain, month on month, produced a deep fear of remaining childless, a situation I simply couldn’t bear. I had always known I wanted children, I never dreamed it may not happen. Over time my mood slipped downwards and I developed a clinical depression. Poor sleep added to my fatigue, which made 20

I started antidepressant therapy, cognitive behaviour therapy and was immediately taken off work. Over the next 3 months I slowly pieced my life, self-worth, hopes and dreams back together and built a stronger support network from my family and friends. I started new hobbies and rediscovered old ones, and most importantly learned the value of taking time to rest. I was offered and accepted a phased return to work and I am now back on the wards and thoroughly enjoying it. In spite of the pain I have been through I feel the experience has been, in some ways, positive. I have experienced the health service as a patient and I have come to understand the deep psychological effect infertility can have on women and the shame that can lead us to hide it from our family, friends and colleagues.

A new dream for the future

References 1. NHS Choices. Infertility. 2012. Webpage, updated 13/02/2012, accessed 05/05/2013. Available at: http://www.nhs.uk/conditions/Infertility/Pages/Introduction.aspx

Useful Links (they helped me!) http://www.mind.org.uk/ http://www.dsn.org.uk/ http://www.gmc-uk.org/concerns/11551.asp http://bma.org.uk/doctorsfordoctors

Medical Woman | Autumn 2013

Listening to theBody

Personal Stories

Photography: Emel Omer

Siobhan Wall is a writer, artist and curator. For over ten years she taught photography, cultural studies, fine art and contemporary curating at universities in Oxford, London and the South East. She now lives in Amsterdam and for the past five years has been writing books about quiet places in busy cities. In 2011 she exhibited at New Hall Art Collection in Cambridge, in a joint show with Dame Paula Rego and she is currently working on a series of drawings for an exhibition in a medical centre in London. For me, drawing is a very seductive way to learn about myself and my body. This is partly because I love d i sc over i n g some t h i n g unexpected about who I might be. I often make soft, pastel images which appear to show surprising tenderness for myself. Following an initial few lines, I might see imaginary women gently exploring their sexuality or discover poignant memories of being a girl. Although I am often surprised by what I draw, it often feels as if my fingers are full of longing to help myself when I am unwell. A few years ago I drew ‘Red Skirt’, a large, elaborate drawing about dysmenorrhoea. In the centre was a silhouette of a woman sitting on the floor covered with intricate flower patterns and making this drawing reminded me of the difficulty of representing such a familiar complaint. Doing small, figurative paintings was probably most helpful after I’d had a few miscarriages. Following a decade of unsuccessful fertility treatments, I was very miserable. During one particularly sad time I drew ‘My Hair Got Mixed Up With My Tears’, an image that allowed me to tell my husband how I was feeling without having to use any words. I was inconsolable about the lost pregnancies and creating the drawings helped remind me that I was not so vulnerable and impotent as I thought. At least I would have a small, precious artwork to look after- a visible reminder that, despite the sadness, I could still be productive and thoughtful. I think the helplessness associated with illness or loss is rarely depicted in art or even talked about in doctor’s surgeries, and I am still curious about how this can be shown without assuming the role of victim. The psychoanalyst Jacqueline Rose said, “Victimhood is something that happens but when you turn it into an identity you’re psychically and politically finished”, a statement which reminded me that when people draw, they can practice escaping from victimhood. I have polycystic ovarian syndrome, for example, and drawing hairy, overweight, spotty female bodies helped me accept my physical imperfections. I also have Menière’s Disease, a condition which is hard to visualise – it is a lot easier for me to draw the loss of a pregnancy than the frustrating consequences of being deaf. Instead, I wrote a practical series of photo books about quiet locations in London and other busy cities so that people can find respite in tranquil places. www.medicalwomensfederation.org.uk

It was very useful reading Susan Sontag’s essay ‘Illness as Metaphor’, as this helped me understand why we are much more likely to see images of death than illness in contemporary art and the mainstream media. What is interesting for me about the process of drawing is that by letting go of expectations, unfamiliar images about my, (and often other women’s), health can emerge and my relationship to my own body can be re-imagined. This allows the shame associated with physical weakness and loss to be transformed into something other and strange. I also have a commitment to making work that supports other women and girls and in particular, their sexual health and attempts to challenge gender based violence. In 2011 I exhibited a series of my drawings alongside etchings by Paula Rego to raise awareness of female genital cutting in Ethiopia for the charity Womankind. I would love to be able to use my drawings in other contexts to help women and girls in difficult and challenging circumstances, either by fundraising or in making illustrated books, which for me are the most accessible art form. Siobhan Wall lives and works in Amsterdam. Her latest book, Quiet Paris, was published by Frances Lincoln in April 2013

‘My hair got mixed up with my tears’

FGM

Female Genital Mutilation (FGM) designing and delivering a dedicated, multidisciplinary service for affected women Dr Lazara Dominguez Garcia Trust Grade Doctor, Chelsea and Wesminter

GM (cutting) involves partial or total excision of the external genitalia for non-therapeutic reasons(1). In its most severe form (infibulation), the clitoris and labia are removed and the vaginal opening is stitched causing a bridge of scar tissue to form, leaving a small opening for the passage of urine and menstrual blood. The practice is associated with significant longterm morbidity including genitourinary infections (GU), transmission of blood-borne viruses, chronic pain and obstetric complications(1). FGM is practised most commonly in 28 African countries. Increasing immigration has led to an estimated 66,000 women in England and Wales living with its consequences. Furthermore, a potential 25, 000 girls are at risk of undergoing FGM each year(2). These women face additional risks related to their ethnic origin and may perceive barriers to accessing support due to stigmatisation of sexual health within their often marginalised communities. In an attempt to address these issues, the West London Centre for Sexual Health (WLCSH) has worked in partnership with the Gynaecology service at Chelsea and Westminster Hospital and a local black and ethnic minority charity, “Opportunity for All”, to design a novel integrated FGM service. We describe its development and a summary of service outcomes.

Organisation and staffing: The FGM service development was shaped by service users and results of previous 22

audits. A welcoming and confidential space was identified at the WLSCH as well as a trained all-female multidisciplinary team. A weekly GU FGM service within the sexual health setting and an on-site fortnightly Gynaecology FGM service were launched in October 2011. The former involves a GU physician and Health Adviser; the latter a Consultant Gynaecologist and a Specialist Midwife. The combined service ensures a seamless, well-coordinated and holistic pathway of care. The Gynaecology FGM clinic is part of the West London African Women’s Service, which also provides specialised hospital-based maternity care. In line with the ethos of GU medicine, clinics are open-access and not restricted by GP registration or postcode of residence. A Somali outreach worker, employed by the aforementioned charity, provides language facilitation and an essential link between the healthcare professionals and the FGM-affected community. She challenges the taboo of sexual health within many of these communities and plays a key role in identifying and engaging affected women. Her support has led to extensive uptake of the service. A set of structured FGM GU pro formas were devised to document key history and examination findings and to support consistent practice. Following a thorough sexual health review in the specialised GU clinic, all women are offered a sexual health screening and examined considering sensitivities relating to their culture. The FGM is graded according to severity. Women with severe type 2 or type

“The service received a Quality Award by the Trustees of Chelsea and Westminster Hospital in 2012 in recognition of the high quality patientcentred care our teams provide.”

3 FGM are counselled on the benefits of de-infibulation (opening of scar tissue) and referred to the Gynaecology FGM team where this procedure can be performed in the clinic setting. Women with co-existent gynaecological problems that may be related to their FGM, such as localised genital pain, superficial dyspareunia and psychosexual problems may also be referred. Medical Woman | Autumn 2013

FGM

Chelsea and Westminster Team

Women are asked regarding the presence of female children in the family and a risk assessment for FGM is performed following national guidance on safeguarding(3). A named social worker has been identified in the event of child protection concerns. Health advisers provide these women with an opportunity to discuss the psychological ramifications of FGM and organise subsequent counselling if required. They facilitate identification of other vulnerability issues such as domestic violence. A health adviser’s pro forma was also developed to enable a more in-depth assessment of safeguarding and to discuss all aspects of the UK legislation. Furthermore, they ensure contact tracing and reinforce prevention methods. The Gynaecology FGM service offers de-infibulation under local anaesthetic, including “one-stop” clinics where assessment and de-infibulation can be performed within the same appointment. For those requesting de-infibulation under general anaesthetic or where input from other specialists is required, onward referral is facilitated.

Summary of outcomes: Fifteen months after it l launch the service has proved extremely popular, with almost 300 women seen to date. The age of those attending ranged from 14 to 75. Over 95% were Somali in origin and all had undergone mutilation in childhood. All were willing to undergo sexual health screening. As expected, high rates of Hepatitis B infection were detected, in conjunction with cases of genital warts, Syphilis, Chlamydia

trachomatis, pelvic inflammatory disease and urinary tract infection. The clinic set-up enables women to be treated promptly and partner notification completed, reducing the risk of onward transmission. All cases of active Hepatitis B have been referred on to our dedicated Hepatitis service. Almost a third of women attending the GU FGM service have required onward referral to the Gynaecology FGM service. In the main, these women presented with issues such as pelvic pain, dyspareunia/apareunia and subfertility. Thirty women had de-infibulation performed, and all chose to have the procedure performed under local anaesthetic in the clinic. Patient feedback has showed high level of satisfaction. In our most recent survey, all women said they would recommend this service to others in their community. The service received a Quality Award by the Trustees of Chelsea and Westminster Hospital in 2012 in recognition of the high quality patient-centred care our teams provide. Our service highlights the value of collaborative work between NHS Directorates and non-government organisations. We have identified a significant burden of sexual ill health and co-existing gynaecological morbidity in women with FGM. Our unique multidisciplinary service represents a holistic model of care tailored to a hard-to-reach population who may not access care through traditional pathways. We believe that similar models of care, implemented in other areas of the UK where FGM prevalence is high could improve health outcomes for this vulnerable and often marginalised group of women.

References 1 WHO. Female Genital Mutilation. Fact sheet no 241. 2012. www.who.int/mediacentre/factsheets/fs241/en/. 2 Dorkenoo E, Morison L, Macfarlane A. A statistical study to estimate the prevalence of female genital mutilation in England and Wales. FORWARD, 2007. www.forward.org.uk/ download/96 3 London Safeguarding Children Board. FGM procedure. Safeguarding children at risk of abuse through female genital mutilation. www.londonscb.gov.uk/fgm/ Lazara Dominguez-Garcia – Genitourinary Medicine Physician, Chelsea & Westminster Hospital NHS Foundation Trust, London Rachael Jones – Consultant Physician, Chelsea & Westminster Hospital NHS Foundation Trust, London Naomi Low-Beer – Consultant Gynaecologist Chelsea and Westminster NHS Foundation Trust, Honorary Senior Clinical Lecturer, Imperial College London

www.medicalwomensfederation.org.uk

Working Abroad

Women The forgotten Dr Jodie February Smythe

ST4 Anaesthetics and ICM, South East School of Anaesthesia, London Deanery

orking in sub-Saharan Africa is a mindblowing, enriching, life changing experience and I loved most moments of it. I was the only medically qualified anaesthetist in maternity in Mbale, an easterly town in Uganda. My role was teaching, supervising and leading the anaesthetic officer students, who have a healthcare background (typically nursing or midwifery) and undertake a two-year course enabling them to deliver anaesthesia. A mother in sub-Saharan Africa is 30 times more likely to lose a newborn than a mother in an industrialised country1 and quite quickly into the 6 months, stillbirths became less emotionally traumatic for me. By the end of the placement I had added last rites for the newborn to my job description. Mbale Regional Referral Hospital sees approximately 5,000 deliveries per year and conservative figures estimate the neonatal mortality rate to be 66 per 1,000 live births. From personal experience this is a gross underestimate. I never became habituated with the mothers who passed away and always felt bereft by their premature demise. I initiated a monthly maternal mortality and morbidity meeting which attempted to have a culture of ‘no blame no shame’ but that was challenging in itself, as on many occasions the death was clearly attributable to an action or inaction of an individual. We addressed the contributing factors in order to prevent the same mistake from being repeated in the future, but in each meeting we discussed the exact same issues. Every meeting would overrun, despite the fact we only ever discussed half the deaths of the previous month.

I want to tell the story of one of the mothers we lost, otherwise she becomes another forgotten woman. I want whoever reads this article to be thankful that when a woman in the UK falls pregnant, it is both normal and expected to congratulate her. In Uganda, I was told that you avoid congratulating the mother until the baby is physically brought home because the outcome is so precarious for the both of them. Sandy* was 22 years old and 35 weeks into her second pregnancy, with one live child. She was referred from her local health centre with sepsis. Her family gave a week’s history of acute confusion, restlessness, anorexia and fevers. She was septic on her arrival with a depressed conscious level, a respiratory rate of 66 breaths per minute and a temperature of 39.9°C. In the health centre, her Widal test was positive and she was being managed for salmonella typhoid. Overnight the Medical Officer queried bowel obstruction as a complication of the typhoid, and referred her for surgical opinion, which never arrived. Antibiotics and oxygen therapy, from an old, but very precious oxygen concentrator were provided. During the morning obstetric meeting, which discusses the events of the night, we were informed of this patient. The Obstetric consultant and I made a beeline for her immediately. As an intensive care trainee I have managed sepsis innumerable times and upon eyeballing her she looked preterminal. Without any intensive care facilities, myself and a student improvised in an attempt to provide as close to level 3 care as possible, and gave continuous positive pressure ventilation, antibiotics, anti-malarials, steroids, a vasopressor and rectal paracetamol, which the family

“I want to tell the story of one of the mothers we lost, otherwise she becomes another forgotten woman. I want whoever reads this article to be thankful that when a woman in the UK falls pregnant, it is both normal and expected to congratulate her.”

Medical Woman | Autumn 2013

Working Abroad

bought from the pharmacy. I also performed tepid sponging as her temperature soared to 42°C. Her prognosis was dismal and if I had the means of quantifying her serum lactate, it would have been in the double figures. The Obstetric Consultant decided on a quasi peri-mortem caesarean section because as the morning progressed she further deteriorated. Knife to skin until closure took 30 minutes and the baby was born hot but with good Apgar scores. On transfer to our recovery (the corridor adjoining labour suite and theatre) she arrested but we achieved return of spontaneous circulation within one cycle. The next five hours were characterised by my makeshift ICU with the only oxygen cylinder from theatre, a portable blood pressure machine and a Lifebox pulse oximeter from the UK and a 10 ml syringe of dilute epinephrine alongside a 10ml syringe of even diluter epinephrine. Meanwhile her family kept her vigil from outside the window. The team was doubtful of her recovery but I knew better because back home we successfully resuscitate the dead. I devised an on call ICU rota for the weekend and recruited a journalist from Minnesota and a visiting Neurosurgeon from Salt Lake City. At 5pm she desaturated, became bradycardic and died as her family continued to look on through the open window. Her sister’s reaction upset me the most. My own sister was 32 weeks’ pregnant and for a split second I empathised whole-heartedly, feeling her exact same grief. But this would never have been Charlie’s fate because we have the remarkable and inequitable fortune of being inhabitants of the industrialised world. www.medicalwomensfederation.org.uk

So this is my tribute: to the forgotten women of Mbale who contribute to the staggering maternal mortality rate, which is even higher than the 2011 estimate of 750 deaths per 100,000 births.2 One day you too may be congratulated when you fall pregnant.

“The team was doubtful of her recovery but I knew better because back home we successfully resuscitate the dead.” References 1. Save the Children. Surviving the First Day: State of the World’s Mothers 2013, May 2013, ISBN 1-888393-26-2. Retrieved on July 11, 2013, from http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0- df91d2eba74a%7D/SOWM-FULL-REPORT_2013.PDF 2. U ganda Bureau of Statistics (UBOS) and ICF International Inc. (2012). Uganda Demographic Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc. Retrieved on April 22, 2013, from http://www.ubos.org/onlinefiles/uploads/ubos/UDHS/UDHS2011.pdf

Health Coaching

Health Coaching Dr Helen MacMullen, FY2, Oxford Deanery

Have you ever wished that your patients would take more responsibility for their own health? Have you ever wondered how different our jobs would be if they acted on advice? Or how their health would be dramatically improved ‘if only they would change… x, y, z’ ?

rom my experience, many health care professionals experience thoughts similar to these on a daily basis, encountering medical conditions and ailments that are likely to either be caused, or made worse, by the way a person chooses to live his or her life. Increasingly, the nation’s health problems have their roots in so-called ‘health behaviours’, or ‘lifestyle choices’ as the medical profession tends to call them. Eighteen million people in the UK live with one or more long-term chronic condition, such as diabetes, depression, heart disease or arthritis, all proven to be linked with lifestyle choices. These people account for nearly 70% of NHS Primary and Secondary care budgets – that’s an awful lot of money! These are potentially preventable, modifiable or even curable diseases, if only these people were able to change their lifestyle.

Empowering Our Patients Despite these facts, we receive little or no training in medical school, or after qualifying, to help either understand behaviour or to facilitate behavioural change in our patients. Added to this is the ‘how can I help you today?’ ethos; a common introductory greeting which serves to empower only the doctor, immediately setting the patient in the passive role. I believe this hinders them in subsequently taking control of their own health. I’ve just attended an incredible and inspirational two day course on Health Coaching, organised by the London Deanery. The aim of the course was to learn questioning and supportive techniques to engage patients in health issues important to both the doctor and the patient thus empowering the patient and ultimately facilitating the change that will have beneficial and lasting effects on his/her health. Whilst it is important that healthcare practitioners understand the facts around what a healthy lifestyle means, being confident in helping to effect change is equally important. That’s where Health Coaching comes in. Coaching is a type of consultation that has been described by Sir John Whitmore as ‘…building awareness, responsibility and self belief’. It is empowering, client-led, action orientated, facilitative and supportive. Essentially, it is a very different way of having a conversation with the patient from how we’ve been taught as doctors. Health coaching can be thought of as: We know that ‘giving advice’ is only effective in changing behaviour in a minority of people, and can potentially damage rapport with those patients who put up barriers in response to 26

“Combining medical knowledge with coaching skills can potentially make a difference.”

being ‘told what to do’. This makes many doctors stop giving advice, or trying to affect lifestyle, because they see it as mostly ineffective, and don’t want to risk ‘switching off’ their patients to future engagement on particular issues.. However, combining medical knowledge with coaching skills can potentially make a difference. The set of skills used in coaching are not new concepts. Many of us will already be using aspects of coaching in our professional and private lives. These ideas have been around for decades and are commonly in use in other professional contexts. I believe we need to introduce these skills at an early stage to doctors, and other healthcare professionals in training.

“The Patient is the expert on themselves” Health coaching recognises that every individual has a different model of reality, different and varying beliefs and values based on experience, and culture. This leads to a different map of the world, different filters through which they experience life..different from ours. One of the most important principles of coaching is that the patients are the expert on themselves. That’s why our solutions are not their solutions. Yes, as ‘experts’ in our field, information and recommendations are important, but what they often need is a combination of advice along with facilitation of self-awareness, to help them understand and overcome barriers to change. They often have their own answers, the ones that work for them, but sometimes it is up to us to bring awareness of those. Health coaching is that it’s not just one thing – it’s an array of different techniques to be used at different times with different people. The aim is to equip ourselves with a ‘toolbox’ of skills to use with different patients at different times. Many people will argue that there’s not enough time to engage in this kind of consultation. They’re right…sometimes there is not, but to have these tools, and to be confident in using them when the right opportunity does arise, is key. As one of my colleagues observed, ‘It’s about the very skilled use of some very simple questions’. Medical Woman | Autumn 2013

Abstract Winner Oral presentation winner at the MWF Oxford Spring Meeting on 10th May 2013

Overcoming cultural barriers

to improve women’s health Miss Nida Kalyal, First year medical student, King’s College London School of Medicine

Girls from Plashet Secondary School for Girls, Newham, & their mothers visit St Bartholomew’s hospital to be shown different processes involved in breast screening, including mammography & breast MRI, as well as being told about warning signs of breast cancer.

n the UK although Black and Asian women are less likely to develop breast cancer, those with breast cancer have poorer survival rates than white women. They have also been reported to have lower breast cancer awareness, in relation to knowledge of symptoms, reported self-examinations and knowledge of the NHS Breast Screening Programme. The reasons for these differences amongst ethnic groups are unclear and we aimed to investigate them in a pilot project, funded by Newham PCT & carried out by Community LINKs. With Black, Asian and Minority Ethnic women (BAME) as our focus, the setting for our study was the London Borough of Newham, one of the most ethnically diverse regions in Britain, with around 65% of residents in the BAME group. Newham has amongst the worst breast cancer survival rates in the country and our project aimed to investigate levels of breast cancer awareness amongst women & girls in the borough. The women we were trying to reach are difficult to recruit in studies; however, we were able to access them through their daughters at a girls secondary school, which was visited over several months to deliver lessons on the signs & symptoms of breast cancer, screening & self examination. We used the Breast Cancer Awareness Measure (BCAM) to assess awareness of breast cancer before and after – the girls were assessed in school and their mothers were assessed at home and at school events. www.medicalwomensfederation.org.uk

Alongside the BCAM, we also spoke to women and girls at the school to get a more detailed understanding on where they stood on women’s health, why they would or would not seek medical advice, and their perception of breast cancer in relation to their community. The BCAM revealed that 29.2% of women could name 5 or more symptoms of breast cancer unprompted after the project compared to 1% at the start; and that there was a 31% increase, to 87%, in the number of women who now knew there that was a breast screening service. Awareness of screening had risen in the girls as well. The number of women who said they would never go to the doctor if they found a change in the breast fell from 5% to 1.6%. There was a clear lack of knowledge and understanding of the disease in this group despite there being a lot of information available. After speaking to women it became apparent that in order to increase breast cancer awareness amongst this group, more targeted health promotion is required. It seems that diversity means that universal messages used in health promotion are not successful in reaching all communities equally. The way in which the message is delivered to them must take into account the openness to images generally used in breast cancer leaflets and literature i.e. more conservative media may be more successful. A significant barrier for improving health in this group of women is that they rank their health very low in their priorities – this is something that is more deeply embedded,

particularly in South Asian cultures, where a woman’s own welfare comes second to the welfare of her family. We spoke to a number of women invited for screening, who said they could not attend because they were always occupied with their children and families. We found that one way of tackling this is to target women through their children and state the importance of their health in relation to their children and their futures. It was believed that the reason for many of these women not seeking medical advice for problems with their breasts was due to cultural reasons; however, it was more the perception of breasts and women’s health as a taboo subject, rather than it actually being a taboo. For example, we visited a community centre mainly attended by South Asian women above the age of 55 and found that they were very open in discussing all aspects of their health, including breast health. Women and girls at the school were initially quite apprehensive about discussing breasts. What is reassuring is that the fear of taboo is not one that is particularly thought about or embedded in their thinking as when it was pointed out that their breasts should be seen just as any other part of your body, they quickly become far more open to information. We found, like other reports about Newham have, that lower literacy levels and language can become barriers to screening take up. Community Links also ran a project to increase screening uptake by training volunteers who spoke different languages, including Urdu and Gujarati, to help women make sense of their mammogram invitations. Following this project, screening uptake increased from 58.5% in January 2010 to 67.1% in March 2011 across Newham. This group of women are hard, but not impossible to reach. By targeting them directly, we can hope to not only improve awareness, but also in the long-run instil in these women a sense of importance about their own health. 27

The Mummy Diaries

T he Mummy Diaries

Dr Ilana Levene, ST 1 Paediatrics, Oxford Deanery

Breastfeeding – the low down and the let down...

“So it turns out breastfeeding isn’t simple, it’s often a focus of great distress for both Mum and baby, and it’s fraught with emotional baggage.”

ike more than 80% of British mums-to-be, I intended to breast feed1. More than that, I assumed I would breast feed, and I was excited about breastfeeding. As a paediatrics trainee I knew the list of benefits – decreased gastroenteritis, respiratory illness, atopy (in high risk families), diabetes, childhood leukaemia, obesity (maybe), ear infections and SIDS (sudden infant death syndrome). Looking back, I was a bit nervous; but mostly I was looking forward to this halcyon bonding process where my baby and I would gaze into each others’ eyes in a rosy halo of skin to skin attachment and milk transfer. Unfortunately, my baby had other ideas. My labour sta rted out quite straightforwardly six days after my due date, but I had a prolonged second stage and was taken to theatre for delivery with forceps. He had a low APGAR initially but improved quickly with minimal intervention, and spent his first few hours gazing into our eyes in a mesmerising fashion. A lovely maternity care assistant positioned him to the breast for me repeatedly in the recovery area but he was more interested in gazing at my breasts in a mesmerising fashion than taking any action. She “helped” me to express colostrum to give him with a syringe (i.e. she milked me!) and I continued to hand express milk after transfer to the ward. For the next three days I called for help every time the baby was hungry. He would either gaze at me lovingly with no sign of a suck, or scream with frustration that his head was being shoved about yet again

when all he wanted was food. Inevitably we had to use bottles to get some nutrition into him; first formula and then breast milk once I could express enough. Various experts gave advice and the general message was that he might just get it one day, or he might not. Ten weeks later I stopped trying to latch him, so that we could have a positive and loving feeding relationship rather than fighting against each other eight times a day. Although the experts told me that nipple confusion didn’t exist, I couldn’t see him wanting to do the hard work of breastfeeding when used to the lovely ease of a bottle. So, I joined the group known as “exclusive pumpers” – I spend 3 hours a day expressing more than a litre of breast milk for my son so that not a drop of formula passes his lips and his poo stays at its sweet smelling breast-y best. Along the way we have endured much crying, screaming and shouting (from both of us), as trying to latch him became more and more invested with distress, and less and

less likely to work. In an attempt to make sure that we had tried absolutely everything we paid for cranial osteopathy sessions, visits from lactation consultants and visited breastfeeding clinics and cafes all over the city. We “skin-to-skinned” until we were pink in the face. My husband suffers the dialogue of my twin personalities: “It’s not a big deal, all that matters is that we have a healthy baby, who cares if he doesn’t breastfeed, formula would be fine anyway” warring with “Everyone is judging me when I bring out a bottle to feed him, I’m not a proper woman if I can’t breastfeed, why is he doing this to me?” Despite mastitis, thrush, blocked ducts so big you can see the ridges through the skin, losing an extra hour of sleep every night, juggling pumping and getting out of the house to stay sane; I cannot stop. I didn’t realise how deeply the idea of breastfeeding was embedded into my vision of myself and my womanhood. By keeping going when most people would stop, I can assuage the guilt that perhaps I didn’t try hard enough, that someone else would have managed to get him to latch. I regularly tell my husband I’m going to start weaning down, but there I am again five times a day pumping away, fighting against the day when I may have to admit that we aren’t going to have that golden 6 months of exclusive breast milk. Although having a baby unable to latch at all is fairly unusual, it is well known to breastfeeding specialists. I have also found that the majority of my committed, educated Medical Woman | Spring 2013

The Mummy Diaries Mummy friends have had significant difficulties with getting a good latch – one (a partner in a successful accountancy firm) described it as the hardest thing she had ever done in her life. I was also surprised to find that mixed feeding (using both formula and breast milk, either from the breast or in bottles) is quite common – the NHS infant feeding survey from 2010 showed that even by 6 weeks of age more Mums are mixed feeding than exclusively breastfeeding (31% vs 24%). Regardless of our medical student teaching, using formula will not crash your milk supply, as long as you continue to use the same amount of formula each day and don’t replace too many feeds too early. So it turns out breastfeeding isn’t simple, it’s often a focus of great distress for both Mum and baby, and it’s fraught with emotional baggage. I have read various helpful blogs from Mums in turmoil over not having the breastfeeding experience they had imagined and these quotes were particularly helpful for me to work through my own feelings: [You feel] “Betrayal as we’ve been told that we can do it – and then we can’t. Breastfeeding backlash baggage in that... you have people disbelieving you, questioning your commitment and motivation. As if it’s a contest, or endurance event, rather than keeping a baby alive by any means necessary. Thwarted in that this was something you made the choice to do and that choice is taken away from you.” – Boobs Half Full blog “True, breastfeeding is physically possible for all but 1-2% of mothers. But... physical possibility is not the only kind of possibility, or even the most important kind. Aside from what’s physically possible... there are (amongst others) the questions of what’s practically possible, of what’s rationally possible, and of what’s emotionally possible... At the point I threw in the towel, continued breastfeeding certainly wasn’t consistent with the emotional state I found myself in. We all have our limits, points at which we simply cannot take any more. So I am finally able to say to myself what I will readily say to anyone who has faced that point where they just can’t see any way of going on: it wasn’t your fault.” – Getting My Breasts Off My Chest blog For me, the big decision is whether to cut down on the pumping and go to mixed feeding, or even exclusive formula. Should www.medicalwomensfederation.org.uk

I set aside my middle class farmers’-marketand-Waitrose-loving dislike for food that comes in powdered form? Is there any evidence out there as to whether some breast milk is as good as only breast milk?

The Evidence

Firstly, a large meta-analysis2 from 2007 describes the best evidence for four major diseases as being “ever breastfed” versus “never breastfed” – these are acute otitis media, overweight, type 2 diabetes and SIDS. So I’m doing well so far – any amount of breast milk brings benefit for these diseases and I’ve already ticked that box. Another study 3 compared exclusive breastfeeding with partial breastfeeding and estimated that 31% of hospitalisations for diarrhoea in infants would be prevented by partial breastfeeding, with an additional 23% being prevented by exclusive breastfeeding; for lower respiratory tract infection 25% of hospitalisations would be prevented by partial breastfeeding, with only an additional 2% prevented by exclusive breastfeeding. So for these diseases, some breast milk can reduce infection significantly; more breast milk gives greater benefit. Another study4 showed that where exclusive breastfeeding halved the chance of having diarrhoea under 7 months old, partial breastfeeding was only marginally worse than exclusive breastmilk (incidences of infection were 11%, 6% and 5% for formula, 58-88% breastmilk – “middle mixed” – and exclusive breastfeeding). The same relationship was shown for otitis media – there were infections in 13% of formula fed babies, 7% of breastfed babies and 9% of “middle mixed” feeding babies. In fact, “high mixed” feeding (89-99% breastmilk) showed slightly lower infection rates than exclusive breastfeeding which suggests that the occasional bottle of formula makes no difference at all for these two diseases, although the study wasn’t powered to look at this level of detail. Even “low mixed” feeding (1-57% breastmilk) reduced ear infection rates from 13% to 11% and this was a statistically significant difference to formula alone. So it’s the same story here – breast milk good, more breast milk better. In two cases there is evidence about how duration of breastfeeding affects the disease prevalence – for diarrhoeal disease the positive effect of breastfeeding lasts no longer than 2 months after stopping, and for overweight there is a 4% decrease in

risk for each month of breastfeeding that the child has2. So in general the evidence supports what a friendly health visitor told me – every day of breast milk is a gift and you should feel proud of what you have given your child, not guilty about what you haven’t. Based on this research my own plan is to start mixed feeding after 3 months of exclusive breast milk, and take it from there based on how my milk supply reacts to weaning down the pumping time. Ideally I would like to continue some breast milk up to 6 months, or even beyond, but it depends on whether my supply will stabilise at a rational amount of pumping time. I hope that it has been helpful, as women and as doctors, to read about my halfway house breastfeeding experience. The key things that I feel are important to think about when dealing with our newly breastfeeding patients, or ourselves and our families, are that breastfeeding is hard, and it’s emotional. . However, wanting to do it may not be enough, and for mothers who desperately want it and can’t, the feeling of failure and guilt is difficult to deal with. I don’t think it’s overstating the case to say that there is a type of grief for the experience that has been taken away from you – denial, anger, bargaining, depression and hopefully acceptance at the end of it all. We should be aware of and validate all safe feeding choices, whether it is exclusive pumping, mixed feeding or exclusive formula. Although breast is best medically, it may not be best socially, emotionally, psychologically, for this baby, this mother, this family. I fully support breastfeeding initiatives to inspire people from all sectors of society to try and breastfeed, and to help those who want to breastfeed to succeed, but let’s balance this with remaining open, empathetic to women’s experiences and choices, and try to put our pre-conceived ideas and judgements on hold. References 1. NHS Information Centre “Infant Feeding Survey 2010” – McAndrew et al 2. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Reports/ Technology Assessments, No. 153. Ip S et al. Agency for Healthcare Research and Quality (US); 2007 3. Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study. Quigley et al. Pediatrics Vol. 119 No. 4 April 1, 2007 pp. e837 -e842 4. A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States. Scariati et al. Pediatrics Vol. 99 No. 6 June 1, 1997 pp. e5

Competition Winner Katherine Branson Essay Competition 2013 Medical Students are invited to submit a short essay (600 words) on either one of two prescribed topics. Winners receive £200 and the chance to present their essay at our Spring Conference. This is another great opportunity to build up your CV!This competition will open again in December 2013

If you were Chief Medical Officer what are the five key priorities for women’s health that you would implement? Miss Vita Sinclair, Medical Student, Kings College London

“When it comes to health, women are often considered in their role as mothers – new, expecting or potential”

hen it comes to health, women are often considered in their role as mothers- new, expecting or potential – needing child-rearing support, antenatal care or contraception. Each of these services is vital for the health of women as well as children, families and society as a whole. However, successes in sexual and reproductive service provision and the changing burden of disease in the UK mean current health priorities for women must change in response. For example, contraception coverage in the UK is currently 84% compared with 74% in 1998, the percentage of births attended by a skilled midwife is the highest in Europe1 and health visitor coverage to new mothers higher than ever previously. However, the benefits of these services are largely reaped in child health and maternal mortality, which has been low in the UK for decades. In the 21st century, several trends stand out in the UK population; increasing life expectancy, a growing mental health burden and increasing lifestyle associated non-communicable diseases (NCDs). This essay suggests that these issues will increasingly affect women and explores the ways in which women’s health can be targeted outside of the times women traditionally come into contact with services. 1) NCD risk factor reduction Cardiovascular and cerebrovascular disease are now the top causes of death among women, and cancers account for a further three of 30

the top ten2. A significant risk factor for all of the above, 20% of the female population still smoke3 and under the age of 16, more girls are smoking than boys4. The 2010 UK Global Burden of Disease study identified risk factors costing the most Disability Adjusted Life Years and, among women, ranked smoking the highest followed by hypertension, high BMI, high cholesterol and physical inactivity5. Medication and the development of statins, has made blood pressure and cholesterol easier to control however the average BMI of women in the UK is now 276, the second highest in Western Europe. Rates of obesity are higher in women than men7 and women on average exercise less, with only one in five reaching the recommended thirty minutes five times weekly8. Women are falling behind men in risk factor reduction for NCDs and interventions must be adapted with young women in mind rather than the middle-aged male of the past. 2) Social care The biggest increase in mortality rates over the past ten years has been in dementia, now the third highest cause of death2 among women and the thirteenth cause of years lived with disability5. As a disease of later life, its rapid ascension is attributed to increasing longevity and, with women living on average five years longer than men3; women will be affected disproportionately by a need for increasing social care. Medical Woman | Autumn 2013

Competition Winner 3) Mental health: Similarly, major depressive disorder is now the third highest cause of years lived with disability4 and women are twice as likely as men to suffer from it9. Increased awareness among GPs, detection of mental health problems in the community and mental health service provision will benefit the population as a whole but women particularly.

Women are key stakeholders in mental health, social care and non-communicable diseases and, just like ‘the girl effect’ in international development, when engaged they will bring their families with them. But whether women have children or not, they will be uniquely affected by and must be at the heart of the solution to the evolving health challenges of the 21st century.

4) Non-doctor-led interventions Each of the interventions mentioned thus far have three qualities in common. They are required in very high numbers, can be delivered by nurses, care assistants or other workers trained in specific tasks e.g. CBT or smoking cessation and they can be delivered in the community. Accordingly, the fourth priority must be the training of staff and allocation space and time in the community for these services in a way which is appealing and accessible to women.

References

5) A cross-sectoral approach Finally, when discussing risk factor reduction, especially those requiring behavioural change, it is important to consider who in the population has them and why before, addressing how changes can be successfully integrated into people’s lives. Many risk factors affect certain populations disproportionately according to gender, ethnicity, geography and level of education10. Complex and interconnected, risk factors are often clustered in populations of low income, reflecting the fact that much of health is determined by factors outside of health service provision and low socio-economic status is a risk factor in itself. This is true of both genders though 29% of women are classed as low-paid compared to 16% of men10 and thus women are more likely to be of lower socioeconomic status. Consequently, a cross-sectoral approach involving education and employment sectors is the final priority this essay suggests in order to address underlying social determinants of health.

1. United kingdom statistics summary. Global health observatory data repository. WHO. Accessible: http://apps.who.int/gho/data/view.country.20600. Accessed 13/03/2012 2. Office of National Statistics (2010). Leading causes of mortality in 2010 Accessible: http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-englandand-wales--series-dr-/2010/stb-deaths-by-cause-2010.html#tab-Leading-causes-ofmortality-in-2010. Accessed 13/03/13. 3. Dunston, S (2010) A report on the General Lifestyle Survey Overview. Figure 1.1. Office of national Statistics. London. 4. NHS Information for smoking and social care (2011). Smoking, drinking and drug use among young people in England, 2010. Accessible: http://data.gov.uk/dataset/ smoking_drinking_and_drug_use_among_young_people_in_england. Accessed: 13/03/2013 5. MURRAY, C.J., RICHARDS, M.A., NEWTON, J.N., et al (2010) UK health performance: findings of the Global Burden of Disease Study 2010. The Lancet. 6. Global Burden of metabolic risk factors for chronic disease. Imperial College London. Accessible:http://www1.imperial.ac.uk/publichealth/departments/ebs/projects/eresh/ majidezzati/healthmetrics/metabolicriskfactors/. Accessed 13/03/13 7. National Obesity Observatory (2010) Trends in Obesity prevalence, figure 2. Accessible: http://www.noo.org.uk/NOO_about_obesity/trends Accessed: 13/03/2013 8. Royal College of General Practitioners (2007) Women’s Health. Accessible: http:// www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview/~/media/Files/ GP-training-and-exams/Curriculum%20previous%20versions%20as%20at%20 July%202012/curr_archive_10_1_Womens_Health_v1_0_feb06.ashx . Accessed: 13/03/2013 9. WHO Department of Mental Health and Substance dependence (2000). Gender and Women’s mental health. WHO. Accessible: http://www.who.int/mental_health/media/ en/242.pdf. 10. Marmot, M (2010) Fair Societies, Healthy Lives. The Marmot Review. Strategic review of Health Inequalities post 2010. London.

3 Months Free Membership & New Online Payments! If you pay to join MWF on 1st October, you will receive 3 months free membership, with nothing more to pay until January 2015! Also you can now pay for membership and events on the MWF website! So, what are you waiting for? Pass this magazine onto your friends, family and work colleagues, it’s about time they took advantage of what MWF has to offer. Become a member at: www.medicalwomensfederation.org.uk

What you get for your membership fees: Medical Woman – Our in-house magazine is issued twice a year in both paper and online formats. Grants, prizes and bursaries – for both Students and Junior Doctors. Support with Awards – we are a nominating body for ACCEA and give support with individual applications from women. We also nominate Medical Women for the Women in the City Award and the Woman of Achievement Award. Networking opportunities – we hold small networking events in our local groups and hold 2 national conferences a year.

MWF is a supportive community which will help boost your CV, confidence and career through to retirement!

www.medicalwomensfederation.org.uk

Working Abroad

Medical Elective: Georgetown

GUYANA

Dr Elizabeth Rose, F1 at the Western General Hospital, Edinburgh Acknowledgements: Ruth C. Derkenne; Vivienne Mitchell; Anita A. Ramlall; Daghni Rajasingam

was extremely fortunate to have the opportunity to travel to Guyana in South America, partly funded by the generous bursary I received from the Medical Women’s Federation. In 2012 I spent 8 weeks carrying out a research project on adolescent pregnancy, as well as gaining valuable clinical experience in Obstetrics and Gynaecology, at the Georgetown Public Hospital Corporation (GPHC). I planned my elective through the Guyana Ministry of Health (MOH) following an internship in adolescent sexual health at the World Health Organisation in Geneva, and had originally wanted to split my time between the MOH and the hospital to build on the work I had done there. A change in government shortly before my arrival left the MOH in chaos and my supervisor fleeing the country! This meant an arduous revision of my study proposal for which I had to re-seek ethical approval; and meant I did not get the public health or rural experience I had been hoping for. However, on the plus side it allowed me more time at the hospital to gain plenty of useful clinical experience, which included outpatient clinics (antenatal and gynae); labour ward (including c-section deliveries); gynaecology theatre experience; specialist trainee’s teaching (various O&G topics); and ward rounds on the neonatal intensive care unit (NICU). In this way I was able to get plenty of hands-on experience, as well as expanding my clinical knowledge. I was also able to see a range of pathologies not often encountered now in the UK such as advanced vulval and cervical carcinoma and severe HIV-related genital lesions. On scoping out the hospital to familiarise myself with the maternity unit, I was introduced to an Australian Consultant with a keen interest in family planning issues and adolescent sexual and reproductive health. She agreed to act as my supervisor and with her I was able to formulate a new

plan to get the most out of my attachment. Subsequently I designed and carried out a study in the hospital – the results of which have already brought about some exciting changes to services for teenagers attending the obstetric unit. Most importantly I have confirmed to myself the area of medicine in which my passion lies. I met a wealth of incredible and inspiring doctors, nurses, midwives, women and girls, and my experience in Guyana has left me more determined than ever to pursue a career in women’s health – be it in the context of Obstetrics and Gynaecology, or Community Sexual and Reproductive Health. The following is a summary of the paper I wrote, outlining the work I carried out with the help and guidance of doctors with a special interest in advancing women’s health in both Guyana and the UK.

Gynae ward

STUDY: Reproductive health knowledge, attitudes and practices, of teenagers attending the Georgetown Public Hospital Corporation (GPHC) Obstetric Unit, Guyana

The Obstetrics Unit at GPHC

SUMMARY Background Teenage pregnancy continues to be a serious global health issue. Problems faced by teenage mothers are biological, social, and psychological. This study sought by way of a questionnaire to formally explore the knowledge, attitudes and practices of pregnant teenagers attending Georgetown Public Hospital Corporation (GPHC), Guyana, where 20% of all births are to teenagers. The findings are important in order to generate evidence for the targeted

The antenatal clinic

Medical Woman | Autumn 2013

Working Abroad

“I designed and carried out a study in the hospital – the results of which have already brought about some exciting changes to services for teenagers attending the obstetric unit. ”

The average age of those interviewed was 15 (range 11-19). 44 girls (88%) were single; 44 (88%) had some level of secondary education; and 35 (70%) of the pregnancies were unplanned. Sexual and reproductive health knowledge was very poor, in particular with regard to contraception.

Interpretation

The beautiful Essequibo River

improvement of services offered, in order to improve reproductive health outcomes amongst these girls.

Methods This was a cross-sectional, prospective study. After IRB approval, fifty pregnant teenagers admitted to the labour/postnatal ward or attending the antenatal clinic during a six week period from 6th August – 14th September, 2012, were interviewed. Using a convenience sample, the principal investigator used a questionnaire to interview participants who had given verbal and written consent. Quantitative and qualitative data on reproductive health issues was analysed using Stata/SE 9.2 (StataCorp., Texas, USA) and Microsoft Excel systems.

Our results showed a lack of sexual and reproductive health knowledge, as well as high risk sexual health practices, among those interviewed. Furthermore, data pertaining to the incidence of sexual violence emerged. A screening and referral system for those at risk, as well as comprehensive antenatal classes tailored to the needs of the local adolescent population, would begin to address specific issues and optimize health outcomes for the women and their babies.

The postnatal ward at GPHC

New c-section deliveries

Funding The Royal College of Obstetricians and Gynaecologists; Ethicon; Wellbeing of Women; Medical Women’s Federation; The Vandervell Foundation.

“ONE PEOPLE, ONE NATION, ONE DESTINY” Source:http://www.flickr.com/photos/9teen87/6887631383/

Findings Fifty girls were interviewed for the study, representing 26% of the 186 admitted to the unit during the 6 week period. www.medicalwomensfederation.org.uk

A church in Georgetown

Careers Clinic

Applying for Surgery Mrs Anna Conway, ST6 General Surgery, South West Thames, London Deanery

urgery is a competitive specialty but this should not put you off. Competition ratios in 2011 and 2012 were 2:1 which is lower than many other specialties. Whilst 55% of medical students are female only 8.7% of consultant surgeons are women. But this is set to change. 26% of surgical trainees were women in 2011, with the highest in general surgery at 37%, the largest surgical specialty[1]. In the South West Thames region there are currently 89 trainees (ST3 or above), 36 are female (40.5%). See table 1 for this years applications to core surgery. There is a broad base of surgical specialties within which you will be able to find your niche if you are curious enough to explore the options. I am currently an ST6 in General Surgery. I’m not sure how I got here so quickly! But I think I’ve have done so by being diligent and reliable at work and easy to get along with whilst jumping through each hoop that is thrown my way. I enjoy my job and that has probably helped a lot. I have definitely had moments where I was truly ready to throw in the towel, but a few side steps and I’m back on the ladder and can see light at the end of the tunnel. I’m not in a rush to become a consultant, but I now have hope that I’ll enjoy my chosen career, a mere 16 years of training. I think finding a role model is difficult if you’re looking for a woman as there aren’t many around, but you can definitely take a lot from enthusiastic trainers who love their job and despite changes in the NHS aren’t ready to throw in the towel – they just love operating! No one ever gets to operate as much as they’d like but it really is the best bit of the specialty. The registrar years suddenly put your years as a CT1 and 2 into perspective where you have so much time for the administration and tick boxing exercise. You take on a lot more responsibility whilst still having to fulfill the usual audits, publications, courses and exam requirements. From doing 6 WBA as an FY1 to needing 80 a year – that is a 13 fold

Round 1 Total Male

Female

Applicants

1295

843 (65%)

440 (34%)

Offers

548

346 (63%)

200 (36%)

Table 1

increase in 7 years! In my region (South West Thames), the majority of on calls are 24 hours. This is much less disruptive than night shifts and means you miss less training opportunities and in general you will get some sleep. I have been fortunate enough to know when I applied for medical school that I wanted to be a surgeon, although I was unsure of the subspecialty. This meant I was able to streamline myself into a good position when the time came to apply for surgery. If you still don’t know, there are plenty of ways in which to fill your application form to win points that will help in any area you apply for. • Taster days are useful if you want to explore an area you didn’t experience much of at medical school, for example ENT or Urology – both of which seem ‘female-friendly’. Speak to the registrars doing the job as they will have more insight into the consultants’ job, which is after all what you are aiming for and can give you an idea about the ups and downs of being a trainee. • The Royal Society of Medicine and the Royal College of Surgeons of England (RCSEng) have many prizes for medical students and junior doctors including the much-coveted Harold Ellis prize for medical students. • You can become an affiliate member of the Royal College of Surgeons of England (RCSEng), Women In Surgery (WinS) and Association of Surgeons in Training (ASiT) as a medical student. These are all useful sources of information and potential areas to publish and present. WinS has a useful area for flexible training if/when you need it. There

are plenty of trainees in my region that have taken maternity leave and organised less than full time training so it is definitely possible. • To apply for Core Surgical Training, most trainees have part A of the MRCS and some have completed their MRCS. Basic surgical skills course is also worth doing. You will soon be able to put these skills to good practice as well as showing evidence that you are serious about surgery. ATLS is also useful and you will need this when applying for ST3. • You should start keeping a logbook of all theatre cases you attend. This can be started when you are a student for every case you attend and then as a house officer for every case you assist and or suture etc. The eLogbook app for smartphones is fantastic as you can do this at the end of each case or list making it much easier to keep up to date. • Other useful apps include the ISCP (although could do with more development), eLogbook, onExamination (SBAs, EMQs on the move), NICE Guidance, BNF, Medscape, Dropbox and Surgical risk are some of the apps I find useful.

Finally, here are two useful website to explore career options: http://www.londondeanery.ac.uk/var/ careers-unit/ http://www.medicalcareers. nhs.uk References [1] http://surgicalcareers.rcseng.ac.uk/wins [2] Core Surgery National Recruitment Office. www.surgeryrecruitment.nhs.uk

Medical Woman | Autumn 2013

Top Tips

TopTIPS

for Medical Students

Clinical attachments Miss Fabienne Verrall & Miss Charley McKerr, 4th & 5th year medical students, University of Bristol Getting started on the busy wards can be pretty intimidating, especially with more care targets and increasing pressure on hospital staff. However we’ve put together some of our top tips for clinical placements to provide some guidance. Some were tips handed down to us, some we had to get wrong before we got them right, and others we learnt after getting a stern word from sister!

1. Always introduce yourself to sister /charge nurse! They’re going to want to know who’s rifling through confidential notes, and can also make your life a lot easier if you very clearly and briefly introduce yourself and what you’re on the ward to do. They will not be pleased if you start examining patients without letting them know. They can also be a good source of which patients are happy to be seen and if anyone needs any bloods or catheters done.

2) Try to learn ward schedules i.e. protected meal times, bedside washes, visiting hours, handover times etc. It pays to know when’s the most productive time to go and also when NOT to interrupt handover!

3) The ward clerk is a wonderful person and can be really helpful especially when everyone else is busy. They can help you find patients all over the hospital, pull notes, find discharge summaries etc.

4) It might seem obvious but be keen! If there are procedures or surgeries that you really want to see then read up beforehand, go to the appropriate person/ place and ask. If you don’t ask then you won’t receive. And if you show that you’ve read around it then you might even get to scrub in and get involved.

5) Practicing clerking on the ward is good but not always beneficial; it can be hard extracting details about what brought them in to hospital initially, especially if the patient feels unwell and just wants to rest. Helping with the on-take is a fantastic and fruitful place to clerk as this is the patient’s first presentation to hospital. It’s also a great place to practice clinical skills like observations, blood taking, blood gases etc. and can be good representation of junior year jobs.

www.medicalwomensfederation.org.uk

6) Don’t be disheartened if you have a bad day! Inevitably, there will be days where your bed side teaching is cancelled, a patient on the ward doesn’t want to talk to you and you missed out on the opportunity to scrub in on an interesting operation. But these are seldom and so you just have to look forward to a new day and stay enthusiastic.

7) Familiarise yourself with the objectives of the unit so you can manage your time efficiently and make the most of the placement. Having your own objectives is also useful, as there may be certain topics that you’re particularly interested in.

8) Don’t be afraid to ask for help. If you feel like you would benefit from more teaching in a certain subject, you will always be able to find a friendly medical student or doctor who will be willing to help you.

9) Get used to being in the way. Medical students have an amazing talent of being able to stand in the most inconvenient places all the time. Unfortunately, this is sometimes unavoidable so just be apologetic and the nurses will forgive you.

10) Get out of your comfort zone and do the things that you’re most apprehensive about at the beginning, whether that be taking blood or examining patients. By tackling your fears head on, you give yourself more time to address them and more time to practice those skills.

Obituaries

Obituaries Bridie Olivia Joanna Wilson Neé Lyons OBE, FFCM, DRCOG (24.02.1926 – 21.07.2012) MWF member for 63 years

Dr Kathleen Mary Helm (24.08.1916 – 05.09.2012) MWF member for 57 years

Bridie Wilson was appointed Consultant in Community Medicine including Care of the Elderly and Mentally Ill to Clwyd Health Authority, where she established a good relationship and liaison with Social Services and the Police. In the mid 1980’s she was an important member of the Most Reverend Alwyn Rice Jones, Bishop of St Asaph’s Group of Inquiry, looking into substance misuse in North Wales which resulted in the formation of CAIS, a Drug and Alcohol Group, to tackle this problem and it’s consequences, particularly in this area. She received an OBE in 1990 for services to Community Medicine, but this was known to very few people. She told close friends that she was off to a Garden! A member of the Wales Assembly of Women, she was past Vice-Chair. She represented North Wales Association on the Council of Medical Women’s Federation, being Secretary and later Secretary/Treasurer of the Association. Bridie was born on 24th February 1926 in Walsall. Her mother died, aged 36, and she was reared by her Aunts – her Aunt Margaret, her mother’s sister being a big influence on her. Bridie did well in school, proceeding to Queen Elizabeth University, Birmingham where she qualified in 1949. She became House Officer to Dame Hilda Lloyd, Consultant in Women’s and Children’s Medicine. She gained the Diploma of the Royal College of Obstetricians and Gynaecology and later became a Fellow of the Faculty of Community Medicine of the Royal College of Physicians. Bridie meet Harold Wilson, a Consultant Physician in Care of the Elderly, in Lancashire and they married in 1956. For the rest of her life she was devoted to him and after he retired they moved to live in Llandudno. Sadly Harold died in 2012, 5 months before her and she then felt that she could go to have treatment for Carcinoma of the breast, from which she died. There were no children of the marriage. Her life was that of service and achievement, with her faith being its guiding principle. I was proud to represent the Federation at her Requiem Mass in Our Lady Star of the Sea Catholic Church in Llandudno on 2nd August 2012. She was buried in a private committal and interment service at Manafon Churchyard, Powys.

On September 5th 2012 a beautiful light was eclipsed in the passing of Dr Kathleen Helm, a single-handed G.P. in Blackpool. She stayed with us until she was 96, but her going nevertheless was too soon to those she left. Her life was a symphony of giving from an extraordinarily loving heart which manifested not only at home with her husband, son and daughter, and subsequently her grand and great-grandchildren, but rippled out endlessly amongst her friends and patients alike. Kathleen graduated from Liverpool University in 1940. Five years later she moved to Blackpool after she had married Harold in the Isle of Man where they had met. She was an early member of the Family Planning Association in 1950’s and also Chairman of the Blackpool and Fylde division of the BMA. Following her retirement she and Harold would spend 5 months of every year in Kalamata in the Pelopponese. Kathleen continued to travel further afield after Harold’s death, metamorphosing into an intrepid explorer in her later years. We visited China and Tibet together and were treated royally to a day in a Tibetan hospital where we were given demonstrations of Tibetan healing - a truly exciting experience for two doctors who had a great leaning towards natural medicine. Sometime later, Kathleen went white-water rafting. The first anyone knew about this escapade was on seeing the photograph of her about to step into the canoe while handing her teeth and glasses over for safe keeping! “Well, I wasn’t going to lose those” she said. After the Irrawaddy called, Kathleen never looked back. This love-affair with Burma blossomed into her annual cruise over many years. Her own words speak clearly about the strong connection she felt: “Only because I plan to return can I bear to leave. The time will come when it will not be so and I will go, leaving behind my heart and taking only my memories.” Kathleen was a deeply spiritual person who respected and valued equally all religions. Eighteen years my senior she was my mentor as well as my most inspiring friend. She nourished my soul with her insights and her compassion. Having the blessing of her friendship allowed me to grow nearer to the person I aspired to be. We had a great bond in both practising meditation, as well as a preference for patients, where appropriate, to allow their amazing minds and bodies to effect a cure rather than rely on medicines. Kathleen famously had a notice in her surgery which read “Your doctor does not believe in drugs!”

By Dr Buddug Owen OBE

By Dr Val Davies, colleague and friend

Recent MWF Member Deaths: • • •

Dr Margaret Calder – Yorkshire & Humber Region, MWF member for 37 years. Dr Anne Gruneber – London. Anne was a valued member of our organisation for 34 years, taking on roles such as Honorary Secretary (1974 – 1979) and sitting on our Executive Committee (2000-2003). Dr Margaret Noble – South East Region (Oxford), MWF member for 57 years.

Medical Woman | Autumn 2013

Dr Iona Frock

Dr Iona Frock Read more about Medical Woman’s fictional character... Dr Catherine Harkin, GP, Scotland Illustration by Laura Coppolaro

The traffic was awful...

Iona’s New Year resolution to try and be more punctual had not lasted beyond the second week of January – no matter how hard she tried she still seemed always to end up screeching into the surgery car park and running in at the last minute. At least now that the children were older she was spared the routine embarrassment of realising that she had come to work with her slippers on or baby sick down the back of her jumper, but it was still not the soignée image of cool professionalism she would have liked to present. Lucy, the practice manager, was at the desk with, as usual, not a hair out of place, looking that very image of cool professionalism and apparently quite unaware of the scene of panic and chaos in the reception office behind her and the queue of patients in front of her. “Morning, Lucy,” said Iona, “What’s up?” “System’s down” said Lucy laconically. “Some kind of upgrade.” There was nothing more to say. Iona fleetingly pondered the irony of the system going down for an upgrade - or should it be up for a downgrade? Lucy was too young to remember the days when general practice relied on primitive methods like writing things on bits of paper. So despite the mutinous roar from the waiting room which was already packed, no meaningful activity could take place until the system came up again; and there was little point in ringing up IT and yelling at them in the hope that next time they might consider the wisdom of organising the upgrade on a Monday morning. www.medicalwomensfederation.org.uk

Iona inclined her head towards the senior partner’s consultingroom door. “Is she in yet?” “Gone to a meeting. Locum’s here though.” Iona walked over to the door with the nameplate that read, “Dr Margaret Comfort”, and stuck her head round it. What appeared to be a fourteen-year-old girl was sitting in the swivel chair with a mug of coffee on the desk in front of her, filing her nails. At the sight of Iona she hastily dropped the nail-file and tapped the computer keyboard hopefully. “Oh hi,” she said, “Are you Dr Frock? Lucy said you’d help me log on because nobody can remember the locum password and I think we’ve crashed the system, sorry...” Iona experienced a strong desire to tell her that she wasn’t being paid hundreds of pounds to treat the place like a beauty parlour and to just get on and start seeing the damn patients, but instead she muttered something about upgrades and retreated. Was it a sign of age when the locums started looking so young? Fortunately, as she entered her own consulting-room the computer screen flickered into life, and a glance at the daybook revealed the joyous news that some of the patients had given up and gone home. Perhaps the day wouldn’t be too bad after all. Then her mobile rang, and Iona’s heart sank as the word “Mum” appeared on the display. Perhaps it would... 37

Medical Women’s Federation

Spring Conference 2014 Friday 9th May 2014 St John’s Hotel, 651 Warwick Rd, Solihull, Birmingham B91 1AT

Diversity

& medical careers Our conference will explore the diversity in medical careers. There will be a range of speakers and workshops examining different career paths for women doctors; including journalism, politics, management, leadership, charity work and more.

The largest body of women doctors in the UK looks forward to meeting you!

Why not submit an Abstract? Deadline – Friday 4th April 2014

You still want more? How about a social programme excellent for networking?! Registration details available at

www.medicalwomensfederation.org.uk MWF, Tavistock House North, Tavistock Square, London WC1H 9HX Email: admin@btconnect.com Tel: 0207 387 7765